Conservative Treatment of Stress Urinary Incontinence: A Systematic Review with Meta-analysis of Randomized Controlled Trials

Abstract

We performed a systematic review and meta-analysis of randomized controlled trials that studied the conservative management of stress urinary incontinence (SUI). There were 1058 results after the initial searches, from which 37 studies were eligible according to previously determined inclusion criteria. For the primary outcomes, pelvic floor muscle training (PFMT) was more efficacious than no treatment in improving incontinence-specific quality of life (QoL) scales (SMD ¼ À1.24SDs; CI 95% ¼ À1.77 to À0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD ¼ À4.4 points; CI 95% ¼ À16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD ¼ 0.9g; 95%CI ¼ 0.71 to 1,10g); group PFMT was not less efficacious than individual treatment, and home PFMT was not consistently worse than supervised PFMT. Both intravaginal and superficial electrical stimulation (IES and SES) were better than no treatment for QoL and pad test. Vaginal cones had mixed results. The association of IES with PFMT may improve the efficacy of the latter for QoL and pad test, but the results of individual studies were not consistent. Thus, there is evidence of the use of PFMT on the treatment of SUI, with and without biofeedback.

Estudos experimentais no período gestacional: panorama da produção científica

“…The morphological changes evidenced in several randomized controlled clinical trials after pelvic floor muscle training allowed to conclude that these exercises are effective in reducing symptoms and/or the stage of POP in middle-aged women, as well as having a potential preventive effect in postpartum prolapse (12) . Recent studies have confirmed that pelvic floor muscle training exercises are effective for treating stress urinary incontinence (SUI) and improving the quality of life of incontinent women (13)(14) . The evidence also indicates that the results are better when pelvic floor exercises are performed weekly under professional supervision (15) .…”

Programa de reabilitação do assoalho pélvico: relato de 10 anos de experiência

“…The surface or intravaginal electrostimulation of the pelvic floor muscles also obtained good results when compared to no type of treatment, once it improved the indexes of quality of life and the results of the pad test (4) . The vaginal cones, in turn, may be an alternative for the woman that does not contract the pelvic floor muscles properly, even performing exercises for strengthening.…”

“…In early study of systematic review, with meta-analysis (4) , one confirmed that the exercises of training of the pelvic floor musculature are affective for the SUI treatment, being this condition the best option for resulting in increase of incontinent women's quality of life. Besides, evidences show that the exercises for the pelvic floor, if performed under professional supervision, at least weekly, presented better results when performed at home, results confirmed in another studies of systematic review (5) .…”

“…The vaginal cones, in turn, may be an alternative for the woman that does not contract the pelvic floor muscles properly, even performing exercises for strengthening. However, as their results were not well documented, it was not possible to determine whether they are superior to other treatments (4) .…”

“…This systematic review (4) suggests that the training of the pelvic floor musculature and the behavioral therapy should be the treatment first line for SUI, with subsequent association with biofeedback, vaginal cones and electrostimulation, approaches also recommended by the Brazilian Federation of Gynecology and Obstetrics [(FEBRASGO)].…”