Bø K, Talseth T, Holme I
Norwegian Centre for Physiotherapy Research and Norwegian University of Sport and Physical Education, PO Box 4014, Ullevâl Stadion, 0806 Oslo, Norway.
BMJ. 1999 Feb 20;318(7182):487-93. doi: 10.1136/bmj.318.7182.487.
To compare the effect of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment for genuine stress incontinence.
Stratified, single blind, randomised controlled trial.
Multicentre.
107 women with clinically and urodynamically proved genuine stress incontinence. Mean (range) age was 49.5 (24-70) years, and mean (range) duration of symptoms 10.8 (1-45) years.
Pelvic floor exercise (n=25) comprised 8-12 contractions 3 times a day and exercise in groups with skilled physical therapists once a week. The electrical stimulation group (n=25) used vaginal intermittent stimulation with the MS 106 Twin at 50 Hz 30 minutes a day. The vaginal cones group (n=27) used cones for 20 minutes a day. The untreated control group (n=30) was offered the use of a continence guard. Muscle strength was measured by vaginal squeeze pressure once a month.
Pad test with standardised bladder volume, and self report of severity.
Improvement in muscle strength was significantly greater (P=0.03) after pelvic floor exercises (11.0 cm H2O (95% confidence interval 7.7 to 14.3) before v 19.2 cm H2O (15.3 to 23.1) after) than either electrical stimulation (14.8 cm H2O (10. 9 to 18.7) v 18.6 cm H2O (13.3 to 23.9)) or vaginal cones (11.8 cm H2O (8.5 to 15.1) v 15.4 cm H2O (11.1 to 19.7)). Reduction in leakage on pad test was greater in the exercise group (-30.2 g; -43. 3 to 16.9) than in the electrical stimulation group (-7.4 g; -20.9 to 6.1) and the vaginal cones group (-14.7 g; -27.6 to -1.8). On completion of the trial one participant in the control group, 14 in the pelvic floor exercise group, three in the electrical stimulation group, and two in the vaginal cones group no longer considered themselves as having a problem.
Training of the pelvic floor muscles is superior to electrical stimulation and vaginal cones in the treatment of genuine stress incontinence.
比较盆底肌锻炼、电刺激、阴道球囊及不治疗对真性压力性尿失禁的效果。
分层、单盲、随机对照试验。
多中心。
107例经临床和尿动力学证实为真性压力性尿失禁的女性。平均（范围）年龄为49.5（24 - 70）岁，平均（范围）症状持续时间为10.8（1 - 45）年。
盆底肌锻炼组（n = 25）每天进行8 - 12次收缩，分3组进行，每周与专业物理治疗师一起进行一次锻炼。电刺激组（n = 25）使用MS 106 Twin进行阴道间歇性刺激，频率为50Hz，每天30分钟。阴道球囊组（n = 27）每天使用球囊20分钟。未治疗的对照组（n = 30）提供尿失禁护垫。每月通过阴道挤压压力测量肌肉力量。
标准化膀胱容量下的护垫试验及严重程度的自我报告。
盆底肌锻炼后肌肉力量改善显著更大（P = 0.03）（锻炼前为11.0 cm H₂O（95%置信区间7.7至14.3），锻炼后为19.2 cm H₂O（15.3至23.1）），优于电刺激组（14.8 cm H₂O（10.9至18.7）对18.6 cm H₂O（13.3至23.9））和阴道球囊组（11.8 cm H₂O（8.5至15.1）对15.4 cm H₂O（11.1至19.7））。锻炼组护垫试验中漏尿量减少幅度（-30.2 g；-43.3至16.9）大于电刺激组（-7.4 g；-20.9至6.1）和阴道球囊组（-14.7 g；-27.6至 -1.8）。试验结束时，对照组有1名参与者、盆底肌锻炼组有14名参与者、电刺激组有3名参与者、阴道球囊组有2名参与者不再认为自己有问题。
在真性压力性尿失禁的治疗中，盆底肌训练优于电刺激和阴道球囊。
