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THE JOURNAL OF FEMALE
URINARY INCONTINENCE

Commented Abstracts

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  • Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials.
    Berghmans, L.C.; Hendriks, H.J.; De Bie, R.A.; Van Doorn, E.S.; Bo, K.; Van Kerrebroeck, P.E.
    Department of Urology, University Hospital Maastricht, The Netherlands.
    Br. J. Urol Int., v. 85, p. 254-63, 2000.

ABSTRACT

OBJECTIVE: To assess the efficacy of physical therapies for first-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 defined by the keywords 'physical therapies', e.g. bladder (re)training (including 'behavioural' treatment), pelvic floor 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 identified; 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 sufficient quality, i.e. an internal validity score of >/= 5.5 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 insufficient 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.

EDITORIAL COMMENT

The treatment of IUU constitutes a challenge for the urologist. Even though stress Urinary Incontinence is more prevalent, urgeincontinence determines a larger negative psychological impact, since Urinary loss, in this case, occurs in unpredictable situations. Isolated individual experiences and several studies have shown that the behavioral treatment, the pelvic floor musculature exercises and electric stimulation could be used successfully in the treatment of these patients1. In the meantime, when these procedures were submitted to a discerning analysis, important methodological failures were observed and a lack of well conducted studies. In Berghmans studies et al 81 publications were reviewed between 1980 and 1999 being that 16 were abridgements. Only 15 complete publications in English, German or Dutch were selected which filled all criteria of inclusion of the authors. With a very rigid criteria base, these results could not define the real efficiency of the conservative treatment as well as the best form of therapy of urgency Urinary Incontinence. There is still a lot to be done in IUU therapy.

Aparecido Donizeti Agostinho


1- Gameiro, M.O.; Amaro, J.L. Intravaginal electrical stimulation (IES) and pelvic floor physiotherapy by treatment of urinary stress incontinence. J. Fem. Ur. Incont. (jinuf.org.br), V. 3, Poster Section, 2000.

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