1% vs 18.6%, respectively).154 The rates of UI were substantially higher after adjuvant hormone therapy and surgery (300 mg of diethylstilbestrol diphosphate per day) compared with adjuvant hormone therapy and external beam radiation (RR 35.5; 95% CI, 2.2–569.3). Patients with total baseline incontinence for more than 6 months after radical retropubic prostatectomy, transvesical prostatectomy, or transurethral prostatectomy reported continence more often after macroplastique injection to the sphincter region of the urethra compared with artificial urethral sphincter implantation (RR 0.3;

Inhibitors,research,lifescience,medical 95% CI, 0.1–0.9).149 Pad utilization was higher after radiotherapy compared with active surveillance (RR 8.3; 95% CI, 1.1–62.6).145 Pharmacologic Treatments for UI Pharmacologic treatments for UI included Inhibitors,research,lifescience,medical antidepressants combined with pelvic floor muscle training,158 muscarinic antagonists,

and adrenergic α-antagonists159–162 (Appendix Table 3 [available at www.medreviews.com]). Duloxetine combined with pelvic floor muscle training Inhibitors,research,lifescience,medical compared with pelvic floor muscle training alone was more effective at 16 but not 24 weeks of treatment158 (Figure 4). Tolterodine alone and combined with tamsulosin resulted in greater perception of overall benefit of the treatment compared with placebo (Figure 4). Adverse events (Appendix Table 3 [available at www.medreviews.com]) included dry mouth and dizziness. Figure 4 Effects of pharmacologic treatments on continence compared with placebo or pelvic floor muscle training (results from Inhibitors,research,lifescience,medical randomized controlled clinical trials). PFMT, pelvic floor muscle training; ER, extended release. Discussion The present report confirmed the significant diversity of interventions used, sampling strategies and definitions, and measurement of outcomes.22,163,164 Preventive nonsurgical interventions were examined in men with prostate diseases but not in patients with Inhibitors,research,lifescience,medical other risk factors for incontinence. Such studies

relied largely on patients in clinics134,135,165 and followed them for less than 6 months,137–139 with few studies reporting long-term outcomes.131,133,134,136 Selection no criteria varied for the same interventions. For example, some trials of pelvic floor muscle rehabilitation after radical prostatectomy excluded patients with prior UI136,166 or severe UI135; others included incontinent patients only.131 Pooled Wortmannin supplier analysis was questionable owing to sampling differences in the present report and previous systematic reviews.167,168 Applicability of observational studies and clinical trials was restricted to the sampled male populations and definitions of incontinence. Whether the same effects would be observed in population-based samples requires future research.