Active encouragement of older women with urinary incontinence in primary care to undergo diagnosis and treatment: A matched-pair cluster randomized controlled trial

• Urinary incontinence is underdiagnosed and undertreated as the majority of affected patients have not sought help.
• Actively encouraging older women with urinary incontinence to undergo diagnosis and treatment results in less severe symptoms.
• That intervention also results in fewer episodes of incontinence, but not in a difference of quality of life scores.

ObjectivesThe URINO trial investigated the effect of offering treatment to older women with urinary incontinence in the general population, who had not sought help on their own initiative.Study designIn a cluster randomized trial, 14 general practitioners were matched into pairs and randomly allocated to an intervention or a control group. Women aged ≥55 years registered in the participating practices were asked about urinary incontinence via a postal questionnaire. Patients in the intervention group were assessed and treated whereas patients in the control group received standard care.Main outcome measuresPrimary outcome was improvement (yes or no) of the severity of symptoms at 12-month follow-up measured with the Incontinence Severity Index. Secondary outcomes were the number of incontinence episodes per day and quality of life. The primary analysis was on an intention-to-treat basis with multiple imputation of missing data. A logistic regression model with correction for cluster randomization was fitted to estimate odds ratios (ORs).ResultsAt 12 months, the severity of symptoms had improved in more patients in the intervention group (n  166) than in the controls (n  184) (OR 1.9; 95% CI 1.1–3.3). Also, the number of patients with fewer episodes of incontinence had increased (OR 2.5; 95% CI 1.5–4.1). No between-group differences in changes in quality of life were apparent (p  0.14).ConclusionsIt is recommended to encourage women in the general population aged ≥55 years with urinary incontinence to undergo diagnosis and treatment.