Reviews should be based on the best evidence available
The paper by Thakar and Stanton[1] is a starting point for examining
evidence on treatment of urinary incontinence in women. Articles were
obtained by MEDLINE search (1966-2000) with subsequent hand searching of
citations, aided by personal experience. However, even a search limited
to MEDLINE would have identified more articles than are cited in the
review, and the authors do not say how they selected articles to use.
Because of the restricted search method, the conclusions that the authors
draw may be misleading. It is of concern that robust evidence, such as
that provided by systematic reviews using meta-analysis based on
randomised controlled trials, was not included.
Systematic reviews do exist in this area. The Cochrane Incontinence
Group has now published 14 systematic reviews in the Cochrane Library[2],
six of which are directly relevant to the review by Thakar and Stanton.
These are reviews on absorbent products, anterior vaginal repair, bladder
training, prompted voiding, suburethral sling operations, and vaginal
cones. In addition, less rigorous systematic reviews have also been
published and not used, for example on surgery[3] and physical
treatment[4].
Further, in a meta-analysis confined to randomised controlled trials,
colposuspension, which is generally considered to be the ‘gold standard’
for surgical management of genuine stress urinary incontinence, was
clearly shown, to be more effective than anterior repair, which is the
traditional operation[5]. Yet the latter is not mentioned in the review.
Clinical reviews are an important source of information for
practitioners. They should be based on the best information available[6].
Yours sincerely
Adrian Grant
June Cody
Cathryn Glazener
Jean Hay-Smith
Peter Herbison
Mela Lapitan
Katherine Moore
Don Wilson
The Editors of the Cochrane Incontinence Group
1. Thakar R, Stanton S. Management of urinary incontinence in women.
BMJ 2000;321:1326–31.
2. The Cochrane Incontinence Review Group, The Cochrane Library, Update
Software, Oxford (2000).
3. Black NA, Downs H. The effectiveness of surgery for stress incontinence
in women: a systematic review. Br.J.Urol. 1996;78:497–510.
4. Berghmans LCM, Hendriks HJM, Bo K, Hay-Smith EJ, de Bie RA, van
Waalwijk van Doorn ESC. Conservative treatment of stress urinary
incontinence in women: a systematic review of randomized clinical trials.
Br.J.Urol. 1998;82:181–91.
5. Glazener CM, Cooper K. Anterior vaginal repair for urinary
incontinence in women (Cochrane Review). In: The Cochrane Library,Update
Software, Oxford 2000, Issue 1.
6. Mulrow CD. Rationale for systematic reviews. BMJ 1994;309:597–9.
On behalf of the Editors of the Cochrane Incontinence Group
Rapid Response:
Reviews should be based on the best evidence available
The paper by Thakar and Stanton[1] is a starting point for examining
evidence on treatment of urinary incontinence in women. Articles were
obtained by MEDLINE search (1966-2000) with subsequent hand searching of
citations, aided by personal experience. However, even a search limited
to MEDLINE would have identified more articles than are cited in the
review, and the authors do not say how they selected articles to use.
Because of the restricted search method, the conclusions that the authors
draw may be misleading. It is of concern that robust evidence, such as
that provided by systematic reviews using meta-analysis based on
randomised controlled trials, was not included.
Systematic reviews do exist in this area. The Cochrane Incontinence
Group has now published 14 systematic reviews in the Cochrane Library[2],
six of which are directly relevant to the review by Thakar and Stanton.
These are reviews on absorbent products, anterior vaginal repair, bladder
training, prompted voiding, suburethral sling operations, and vaginal
cones. In addition, less rigorous systematic reviews have also been
published and not used, for example on surgery[3] and physical
treatment[4].
Further, in a meta-analysis confined to randomised controlled trials,
colposuspension, which is generally considered to be the ‘gold standard’
for surgical management of genuine stress urinary incontinence, was
clearly shown, to be more effective than anterior repair, which is the
traditional operation[5]. Yet the latter is not mentioned in the review.
Clinical reviews are an important source of information for
practitioners. They should be based on the best information available[6].
Yours sincerely
Adrian Grant
June Cody
Cathryn Glazener
Jean Hay-Smith
Peter Herbison
Mela Lapitan
Katherine Moore
Don Wilson
The Editors of the Cochrane Incontinence Group
1. Thakar R, Stanton S. Management of urinary incontinence in women.
BMJ 2000;321:1326–31.
2. The Cochrane Incontinence Review Group, The Cochrane Library, Update
Software, Oxford (2000).
3. Black NA, Downs H. The effectiveness of surgery for stress incontinence
in women: a systematic review. Br.J.Urol. 1996;78:497–510.
4. Berghmans LCM, Hendriks HJM, Bo K, Hay-Smith EJ, de Bie RA, van
Waalwijk van Doorn ESC. Conservative treatment of stress urinary
incontinence in women: a systematic review of randomized clinical trials.
Br.J.Urol. 1998;82:181–91.
5. Glazener CM, Cooper K. Anterior vaginal repair for urinary
incontinence in women (Cochrane Review). In: The Cochrane Library,Update
Software, Oxford 2000, Issue 1.
6. Mulrow CD. Rationale for systematic reviews. BMJ 1994;309:597–9.
On behalf of the Editors of the Cochrane Incontinence Group
Competing interests: No competing interests