Aims of Study

Prompted voiding is a behavioural therapy used mainly in North American nursing homes.  It aims to improve bladder control for people with or without dementia using verbal prompts and positive reinforcement.  We aimed to assess the effects of prompted voiding for the management of urinary incontinence in adults.

Methods

Randomised or quasi-randomised trials which addressed prompted voiding for the management of urinary incontinence were identified from the Cochrane Incontinence Group trials register and reference lists of relevant articles.  We also contacted investigators in the field to locate extra studies.  The date of the most recent search was February 2000. The trials included adult men and women, with or without cognitive impairment, diagnosed as having urinary incontinence as identified by the trialists, either by symptom classification or by urodynamic investigation. The identified reports were assessed for eligibility. Two reviewers independently reviewed the selected studies for methodological quality. Data describing six pre-specified outcomes were extracted independently by each reviewer and consensus reached when there was disagreement. Trial investigators were consulted when clarification or further detail was required. A third reviewer was recruited to proof read the review at different stages.

Results

Five trials were included in the review.  These involved 355 elderly people, most of whom were women.  One other trial was excluded because no relevant outcome data were reported, and one trial is awaiting assessment.  Prompted voiding was compared with no prompted voiding in four trials.  The limited evidence suggested that prompted voiding increased self-initiated voiding and decreased incontinent episodes in the short-term.  There was no evidence about long-term effects.

A single small trial suggested that adding the muscle relaxant, Oxybutinin, reduced the number of incontinent episodes in the short-term: this study used a cross-over design and so did not address long-term effects.

Conclusions

There was insufficient evidence to reach firm conclusions for practice. There was suggestive, although inconclusive, evidence of short-term benefit from prompted voiding and from adding the muscle relaxant, Oxybutinin to prompted voiding.