A randomized trial comparing continence pessary to continence device (Poise Impressa®) for stress incontinence.

Abstract

To conduct a multi-centered randomized trial evaluating stress urinary incontinence (SUI) treatment based on the Patient Global Impression of Improvement score after 4weeks using a continence pessary (CP) or a disposable intravaginal continence device (DICD). The null hypothesis is no difference in treatment success between cohorts. This parallel group, active treatment comparative effectiveness trial randomized women with SUI to either CP or DICD for 4weeks in a 1:1 allocation ratio. Exclusion criteria included pregnancy, UTI, postmenopausal bleeding, neurogenic bladder, urinary retention, prolapse, contraindication to or prior treatment with CP/DICD, and prior SUI surgery. Assuming an80% power, an alpha of 5% and 20% dropout, we needed 138 participants to detect 50% success with CP versus 25% with DICD. Due to slow enrollment, the study was stopped after 16months with 50 participants enrolled. Of the 50 women enrolled, 25 (50%) were randomized to CP and 25 (50%) to DICD. Thirty-five of 50 (70%) completed a fitting, and 22/50 (44%) completed 4-week and 17/50 (34%) completed 6-month follow-up. Baseline characteristics were similar, and there was high treatment success in each cohort [80% (8/10) CP vs. 75% (9/12) DICD; p= 1.0]. DICD patients showed improvement on all questionnaires but had higher use of other therapies over 6months. CP patients showed improvements except for lower sexual function scores at 4weeks. No serious adverse events occurred. Most women fitted with a CP/DICD experienced treatment success after 4weeks without serious adverse events.