Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials

Abstract

Objective To assess the ef®cacy of physical therapies for ®rst-line use in the treatment of urge urinary incontinence (UUI) in women, using a systematic review of randomized clinical trials (RCTs). Materials and methods A computer-aided and manual search was carried out for RCTs published between 1980 and 1999 investigating the treatment of UUI de®ned by the keywords`physical therapies', e.g. bladder (re)training (including`behavioural' treatment), pelvic¯oor muscle (PFM) exercises, with or without biofeedback and/or electrical stimulation. The methodological quality of the included trials was assessed using methodological criteria, based on generally accepted principles of interventional research. Results Fifteen RCTs were identi®ed; the methodological quality of the studies was moderate, with a median (range) score of 6 (3±8.5) (maximum possible 10). Eight RCTs were considered of suf®cient quality, i.e. an internal validity score of o5.5 points on a scale of 0± 10, and were included in a further analysis. Based on levels-of-evidence criteria, there is weak evidence to suggest that bladder (re)training is more effective than no treatment (controls), and that bladder (re)training is better than drug therapy. Stimulation types and parameters in the studies of electrical stimulation were heterogeneous. There is insuf®cient evidence that electrical stimulation is more effective than sham electrical simulation. To date there are too few studies to evaluate effects of PFM exercise with or without biofeedback, and of toilet training for women with UUI. Conclusion Although almost all studies included reported positive results in favour of physical therapies for the treatment of UUI, more research of high methodological quality is required to evaluate the effects of each method in the range of physical therapies.

Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence

“…92,93 From a health service perspective it is important to balance short-and long-term effectiveness against the potential adverse events and costs. Compared with surgical treatments, non-surgical treatments, such as lifestyle changes and physical therapies (such as PFMT), are associated with limited side effects and do not preclude future changes in management.…”

Avaliação da qualidade de vida e da perda urinária de mulheres com bexiga hiperativa tratadas com eletroestimulação transvaginal ou do nervo tibial

“…Basicamente, seu objetivo é inibir a contração involuntária do detrusor 10 . Diversos estudos 3,11,12 verificaram boa efetividade no tratamento da BH com a utilização da eletroestimulação transvaginal (ET).…”

Physical therapy treatment in incontinent women provided by a Public Health Service

“…By means of audible or visual biofeedback, the patient acquires information on the physiological process of contraction, which was unknown in most cases until then (27). Aukee et al (28) observed significant improvement in the strengthening of the PF muscle in women with UI who had undergone biofeedback and kinesiotherapy treatment, within a twelve-year period.…”