Continence pessary compared with behavioral therapy or combined therapy for stress incontinence: a randomized controlled trial.

Journal Article (Journal Article;Multicenter Study)

OBJECTIVE: To compare the effectiveness of a continence pessary to evidence-based behavioral therapy for stress incontinence and to assess whether combined pessary and behavioral therapy is superior to single-modality therapy. METHODS: This was a multisite, randomized clinical trial (Ambulatory Treatments for Leakage Associated with Stress Incontinence [ATLAS]) that randomly assigned 446 women with stress incontinence to pessary, behavioral therapy, or combined treatment. Primary outcome measures, at 3 months, were Patient Global Impression of Improvement and the stress incontinence subscale of the Pelvic Floor Distress Inventory. A priori, to be considered clinically superior, combination therapy had to be better than both single-modality therapies. Outcome measures were repeated at 6 and 12 months. Primary analyses used an intention-to-treat approach. RESULTS: At 3 months, scores from 40% of the pessary group and 49% of the behavioral group were "much better" or "very much better" on the Patient Global Impression of Improvement (P=.10). Compared with the pessary group, more women in the behavioral group reported having no bothersome incontinence symptoms (49% compared with 33%, P=.006) and treatment satisfaction (75% compared with 63%, P=.02). Combination therapy was significantly better than pessary as shown on the Patient Global Impression of Improvement (53%, P=.02) and Pelvic Floor Distress Inventory (44%, P=.05) but not better than behavioral therapy; it was therefore not superior to single-modality therapy. Group differences were not sustained to 12 months on any measure, and patient satisfaction remained above 50% for all treatment groups. CONCLUSION: Behavioral therapy resulted in greater patient satisfaction and fewer bothersome incontinence symptoms than pessary at 3 months, but differences did not persist to 12 months. Combination therapy was not superior to single-modality therapy. CLINICAL TRIAL REGISTRATION:,, NCT00270998.

Full Text

Duke Authors

Cited Authors

  • Richter, HE; Burgio, KL; Brubaker, L; Nygaard, IE; Ye, W; Weidner, A; Bradley, CS; Handa, VL; Borello-France, D; Goode, PS; Zyczynski, H; Lukacz, ES; Schaffer, J; Barber, M; Meikle, S; Spino, C; Pelvic Floor Disorders Network,

Published Date

  • March 2010

Published In

Volume / Issue

  • 115 / 3

Start / End Page

  • 609 - 617

PubMed ID

  • 20177294

Pubmed Central ID

  • PMC2914312

Electronic International Standard Serial Number (EISSN)

  • 1873-233X

Digital Object Identifier (DOI)

  • 10.1097/AOG.0b013e3181d055d4


  • eng

Conference Location

  • United States