Hay-Smith J, Herbison P, Mørkved S
Department of Women's and Children's Health, University of Otago, PO Box 913, Dunedin, New Zealand.
Cochrane Database Syst Rev. 2002(2):CD003191. doi: 10.1002/14651858.CD003191.
Physical therapies, particularly pelvic floor muscle training, have been recommended for prevention of incontinence associated with childbearing, and prostate surgery.
To assess the effectiveness of physical therapies in preventing incontinence in adults.
The Cochrane Incontinence Group trials register was searched to September 2001. Trials were also sought from the Reference Lists of relevant articles and from experts in the field.
Randomised and quasi-randomised trials in adults without incontinence symptoms that compared a physical therapy with no treatment, or any other treatment to prevent incontinence.
Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Collaboration Handbook.
Two trials in men (155 men) and 13 trials in women (4661 women) were included. As most trials recruited regardless of continence status, and there was much heterogeneity, only a qualitative synthesis was undertaken. Three of seven trials in childbearing women reported less urinary incontinence after pelvic floor muscle training compared to control treatment three months postpartum. Two trials selected women at higher risk of postnatal incontinence. The third used an intensive training programme. Four trials did not find any difference between the groups at the primary endpoint. Two trials compared pre-prostate surgery pelvic floor muscle training with control treatment, and no difference in the occurrence of postoperative urinary incontinence was reported between the groups.
REVIEWER'S CONCLUSIONS: There is insufficient evidence to determine whether physical therapies can prevent incontinence in childbearing women, or men following prostate surgery. Further, better quality research is needed.
物理疗法，尤其是盆底肌肉训练，已被推荐用于预防与分娩及前列腺手术相关的尿失禁。
评估物理疗法在预防成人尿失禁方面的有效性。
检索了Cochrane尿失禁小组试验注册库至2001年9月。还从相关文章的参考文献列表及该领域专家处获取试验。
针对无尿失禁症状的成年人进行的随机和半随机试验，比较了物理疗法与不治疗或任何其他预防尿失禁的治疗方法。
两名评价员独立评估纳入标准、试验质量并提取数据。数据按照Cochrane协作网手册中的描述进行处理。
纳入了两项男性试验（155名男性）和13项女性试验（4661名女性）。由于大多数试验招募时未考虑尿失禁状态，且存在很大异质性，因此仅进行了定性综合分析。七项分娩后女性试验中的三项报告称，与产后三个月的对照治疗相比，盆底肌肉训练后尿失禁较少。两项试验选择了产后尿失禁风险较高的女性。第三项试验采用了强化训练方案。四项试验在主要终点未发现组间有任何差异。两项试验比较了前列腺手术前盆底肌肉训练与对照治疗，两组术后尿失禁发生率未见差异。
尚无足够证据确定物理疗法能否预防分娩后女性或前列腺手术后男性的尿失禁。此外，需要开展质量更高的研究。
