Latthe P M, Foon R, Khan K
Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK.
BJOG. 2008 Mar;115(4):435-44. doi: 10.1111/j.1471-0528.2007.01629.x.
The guidance on SUI has not been rigorously assessed using GRADE system.
To determine if the quality and results of existing systematic reviews on conservative treatment of stress urinary incontinence (SUI) can underpin evidence-based recommendations for practice.
Review of systematic reviews. Data sources Electronic search in PubMed, Medline (OVID 1966-version), CINAHL, Biomed, Psychinfo, the Cochrane library, National Library for Health, the National Research Register and hand search of reference lists.
Two reviewers independently selected systematic review articles in which a publicly available database was searched for randomised trials on conservative treatment of SUI and assessed them for quality of methods and results (OR and 95% CIs). The extracted information was used to classify strength of evidence as per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.
There were 13 reviews of variable quality. Quality assessment of studies included in the reviews and their findings were adequately tabulated in all but four reviews. Meta-analysis of data was carried out in six reviews. Pelvic floor muscle training (PFMT) and other physical treatments, estrogens and duloxetine were better than no treatment in SUI. Based on the assessment as per GRADE system, only 2/13 (15.4%) reviews were deemed to be of high quality, 8/13 (61.5%) of moderate quality and 3/13 (23.1%) of low quality. The case for recommendation of PFMT and duloxetine was strong.
Systematic reviews of conservative treatments of SUI are not always suitable to generate robust recommendations for practice as they are weak in methodological quality or lack power to produce reliable results.
关于压力性尿失禁（SUI）的指南尚未使用GRADE系统进行严格评估。
确定现有关于压力性尿失禁保守治疗的系统评价的质量和结果是否能够为基于证据的实践建议提供支持。
系统评价的综述。数据来源在PubMed、Medline（OVID 1966版）、CINAHL、Biomed、Psychinfo、Cochrane图书馆、国家健康图书馆、国家研究注册库进行电子检索，并手工检索参考文献列表。
两名评价者独立选择系统评价文章，其中搜索了公开可用数据库以查找关于SUI保守治疗的随机试验，并评估其方法和结果的质量（OR和95%CI）。提取的信息用于根据推荐分级、评估、制定和评价（GRADE）系统对证据强度进行分类。
有13项质量参差不齐的综述。除4项综述外，其他综述均对纳入研究的质量评估及其结果进行了充分列表。6项综述进行了数据的荟萃分析。盆底肌训练（PFMT）和其他物理治疗、雌激素和度洛西汀在SUI治疗中比不治疗更好。根据GRADE系统的评估，只有2/13（15.4%）的综述被认为是高质量的，8/13（61.5%）为中等质量，3/13（23.1%）为低质量。推荐PFMT和度洛西汀的理由很充分。
关于SUI保守治疗的系统评价并不总是适合为实践产生有力的建议，因为它们在方法学质量上较弱或缺乏产生可靠结果的能力。
