Lipp Allyson, Shaw Christine, Glavind Karin
Faculty of Health, Sport and Science, Department of Care Sciences, University of Glamorgan, Glyn Taff Campus, Pontypridd, Rhondda Cynon Taff, UK, CF37 1DL.
Cochrane Database Syst Rev. 2011 Jul 6(7):CD001756. doi: 10.1002/14651858.CD001756.pub5.
ncontinence can have a devastating effect on the lives of sufferers with significant economic implications. Non-surgical treatments such as pelvic floor muscle training and the use of mechanical devices are usually the first line of management, particularly when a woman does not want surgery or when she is considered unfit for surgery. Mechanical devices are inexpensive and do not compromise future surgical treatment.
To determine the effects of mechanical devices in the management of adult female urinary incontinence.
We searched the Cochrane Incontinence Group Specialised Register (searched 23 June 2010), EMBASE (January 1947 to 2010 Week 24), CINAHL (January 1982 to 11 June 2010) and the reference lists of relevant articles.
All randomised or quasi-randomised controlled trials of mechanical devices in the management of adult female urinary incontinence determined by symptom, sign or urodynamic diagnosis.
The reviewers assessed the identified studies for eligibility and risk of bias and independently extracted data from the included studies. Data analysis was performed using RevMan software (version 5.0.25).
One new trial was identified and included in this update bringing the total to seven trials involving 732 women. Two small trials compared a mechanical device with no treatment and although they suggested that use of a mechanical device might be better than no treatment, the evidence for this was inconclusive. Four trials compared one mechanical device with another. Quantitative synthesis of data from these trials was not possible because different mechanical devices were compared in each trial using different outcome measures. Data from the individual trials showed no clear difference between devices, but with wide confidence intervals. One new trial compared three groups: a mechanical device alone, behavioural therapy (pelvic floor muscle training) alone and behavioural therapy combined with a mechanical device. While at three months, there were more withdrawals from the device-only group, at 12 months group differences between the groups were not sustained on any measure.
AUTHORS' CONCLUSIONS: The place of mechanical devices in the management of urinary incontinence remains in question. Currently there is little evidence from controlled trials on which to judge whether their use is better than no treatment and large well-conducted trials are required for clarification. There was also insufficient evidence in favour of one device over another and little evidence to compare mechanical devices with other forms of treatment.
尿失禁会对患者的生活产生毁灭性影响，并带来重大经济影响。非手术治疗，如盆底肌训练和使用机械装置，通常是一线治疗方法，特别是当女性不想接受手术或被认为不适合手术时。机械装置价格低廉，且不会影响未来的手术治疗。
确定机械装置在成年女性尿失禁管理中的效果。
我们检索了Cochrane尿失禁小组专业注册库（检索时间为2010年6月23日）、EMBASE（1947年1月至2010年第24周）、CINAHL（1982年1月至2010年6月11日）以及相关文章的参考文献列表。
所有通过症状、体征或尿动力学诊断确定的关于机械装置在成年女性尿失禁管理中的随机或半随机对照试验。
reviewers评估了纳入研究的合格性和偏倚风险，并独立从纳入研究中提取数据。使用RevMan软件（版本5.0.25）进行数据分析。
本次更新中确定并纳入了一项新试验，使试验总数达到七项，涉及732名女性。两项小型试验将一种机械装置与不治疗进行了比较，尽管它们表明使用机械装置可能比不治疗更好，但这方面的证据尚无定论。四项试验将一种机械装置与另一种进行了比较。由于每项试验中使用不同的结局指标比较了不同的机械装置，因此无法对这些试验的数据进行定量综合分析。各单项试验的数据显示，不同装置之间没有明显差异，但置信区间较宽。一项新试验比较了三组：单独使用机械装置、行为疗法（盆底肌训练）以及行为疗法与机械装置联合使用。虽然在三个月时，仅使用装置组的退出人数更多，但在12个月时，各小组在任何指标上的差异都没有持续存在。
机械装置在尿失禁管理中的地位仍存在疑问。目前，对照试验几乎没有证据可据此判断其使用是否优于不治疗，需要进行大规模的高质量试验来澄清这一点。也没有足够的证据支持一种装置优于另一种装置，且几乎没有证据将机械装置与其他治疗形式进行比较。
