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

Objective To assess the efficacy of physical therapies for first-line use i n the treatment of urge urinary incontinence (UUI) in women, using a system atic review of randomized clinical trials (RCTs). Materials and methods A computer-aided and manual search was carried out fo r RCTs published between 1980 and 1999 investigating the treatment of UUI d efined by the keywords 'physical therapies', e.g. bladder (re)training (inc luding 'behavioural' treatment), pelvic floor muscle (PFM) exercises, with or without biofeedback and/or electrical stimulation. The methodological qu ality of the included trials was assessed using methodological criteria, ba sed on generally accepted principles of interventional research. Results Fifteen RCTs were identified; the methodological quality of the stu dies was moderate, with a median (range) score of 6 (3-8.5) (maximum possib le 10). Eight RCTs were considered of sufficient quality, i.e. an internal validity score of greater than or equal to 5.5 points on a scale of 0-10, a nd were included in a further analysis. Based on levels-of-evidence criteri a, there is weak evidence to suggest that bladder (re)training is more effe ctive than no treatment (controls), and that bladder (re)training is better than drug therapy, Stimulation types and parameters in the studies of elec trical stimulation were heterogeneous. There is insufficient evidence that electrical stimulation is more effective than sham electrical simulation, T o date there are too few studies to evaluate effects of PFM exercise with o r without biofeedback, and of toilet training for women with UUI, Conclusion Although almost all studies included reported positive results i n favour of physical therapies for the treatment of UUI, more research of h igh methodological quality is required to evaluate the effects of each meth od in the range of physical therapies.