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 = -1.24SDs; CI 95% = -1.77 to -0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD = -4.4 points; CI 95% = -16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD = 0.9g; 95%CI = 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.
Highlights
Urinary incontinence (UI) is a very common condition among women, with reported annual incidences of 1% to 35%1, and a lifetime risk of surgery of 11% to 13%.2,3 Its impact on quality of life is significant, leading to physical and social limitations, shame, and increased rates of depressive symptoms.[4]
When we measured a single continuous outcome using different scales in different studies, we summarized the outcome by using the standardized mean difference (SMD)
The study selection process is illustrated in a PRISMA flowchart presented in ►Fig. 1. ►Table 1 shows the characteristics of included studies
Summary
Urinary incontinence (UI) is a very common condition among women, with reported annual incidences of 1% to 35%1, and a lifetime risk of surgery of 11% to 13%.2,3 Its impact on quality of life is significant, leading to physical and social limitations, shame, and increased rates of depressive symptoms.[4]. Its impact on quality of life is significant, leading to physical and social limitations, shame, and increased rates of depressive symptoms.[4] Stress urinary incontinence (SUI) is the most common subtype of UI, and its treatment is predominantly surgical, after the introduction of synthetic midurethral slings in the mid-nineties, which led to less invasive surgical procedures. Surgical treatment may lead to complications, directly or indirectly related to the use of synthetic materials.[5] conservative treatment is considered the first-line option for managing women with SUI.[6]. The objective of this review is different from the previously published systematic reviews; we aimed to pool randomized trials which compared multiple forms of conservative treatment (alone or in association) between each other, with control groups or surgical treatments, emphasizing treatment options that are available in Brazil due to the lack of guidelines for these practitioners
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