CONSERVATIVE TREATMENT OF STRESS URINARY-INCONTINENCE IN WOMEN - A SYSTEMATIC REVIEW OF RANDOMIZED CLINICAL-TRIALS

Objective To assess the efficacy of physical therapies for first-line use in the treatment and prevention of stress urinary incontinence (SU I) in women, using a systematic review of randomized clinical trials ( RCTs). Materials and methods A computer-aided and manual search for pu blished RCTs investigating treatment and prevention of SUI using physi cal therapies, e,g. pelvic floor muscle (PFM) exercises, with or witho ut other treatment modalities, was carried out. The methodological qua lity of the included trials was assessed using criteria based on gener ally accepted principles of interventional research. Results Twenty-fo ur RCTs (22 treatment and two prevention) were identified: the methodo logical quality of the studies included was moderate and 11 RCTs were of sufficient quality to be included in further analysis. Based on lev els-of-evidence criteria, there is strong evidence to suggest that PFM exercises are effective in reducing the symptoms of SUI. There is lim ited evidence for the efficacy of high-intensity vs a low-intensity re gimen of PFM exercises. Despite significant effects of biofeedback aft er testing as an adjunct to PFM exercises, there is no evidence that P FM exercises with biofeedback are more effective than PFM exercises al one, There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, but when the results are co mbined there is strong evidence to suggest that electrostimulation is superior to sham electrostimulation, and limited evidence that there i s no difference between electrostimulation and other physical therapie s, In the prevention of SUI the efficacy of PFM exercises, with or wit hout other adjuncts, is uncertain. Conclusions More research of high m ethodological quality is required to further evaluate the effects of p hysical therapies used to treat and prevent SUI.