Ferreira Margarida, Santos Paula
Centro Hospitalar do Alto Ave, Escola Superior de Saúde do Vale do Sousa, Guimarães, Portugal.
Acta Med Port. 2011 Mar-Apr;24(2):309-18. Epub 2011 May 20.
Stress urinary incontinence (SUI) is involuntary leakage from effort or exertion or from sneezing or coughing and it is usually related to increased urethral mobility and/or poor intrinsic sphincter function. Pelvic floor muscle training (PFMT) has principally been recommended in the management of SUI. The aims of PFMT are to improve pelvic organ support (bladder, bladder neck, and urethra) and increase intraurethral pressure during exertion. The PFMT programmes are prescribed to increase strength, endurance and coordination muscle.
To determine the effects of pelvic floor muscle training in the management of female stress urinary incontinence. The following hypothesis was tested: What is the evidence for PFMT, either alone or in combination with adjunctive therapies? What is the evidence for different types of PFMT? What is the length of treatment and number of PFMT?
[corrected] Types of studies: randomised controlled trials and quasirandomised studies were included. Searches of MEDLINE, PUBMED, COCHRANE, PEDro e SCOPUS review articles published between 1999-2009.
all women with stress urinary incontinence and diagnosed on the basis of symptoms, signs, or urodinamic evaluation. Other forms of controlled clinical trial were excluded, for example whose symptoms might be due to significant factors outside the urinary tract (neurological disorders, cognitive impairments, lack of independent mobility).
PFMT was defined as a programme of repeated voluntary pelvic floor muscle contraction and with or without supervised by health care professional. All studies were eligible for inclusion if there was at least one arm with a PFMT protocol, alone or together with other adjunctive therapies (biofeedback, electrical stimulation or vaginal weights) compared with or without control group.
The outcomes of interest were symptomatic cure and cure/improvement; symptom and condition specific quality of life assessment, quantification of leakage episodes; measures of pelvic floor muscle contraction.
Nineteen studies met the inclusion criteria. The review found consistent evidence from of high quality randomised controlled trials, that PFMT alone and in combination with adjunctive therapies (biofeedback and electrical stimulation) was effective treatment for women with SUI with of «cure» and «cure/improvement» up to 70% and 97% respectively.
Based on the few data available there is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further studies are needed to evaluate the optimal training protocol and length of treatment.
压力性尿失禁（SUI）是指因用力、运动、打喷嚏或咳嗽而导致的不自主漏尿，通常与尿道活动度增加和/或尿道固有括约肌功能不良有关。盆底肌训练（PFMT）主要被推荐用于压力性尿失禁的治疗。盆底肌训练的目的是改善盆腔器官支撑（膀胱、膀胱颈和尿道），并在用力时增加尿道内压。盆底肌训练方案旨在增强肌肉力量、耐力和协调性。
确定盆底肌训练对女性压力性尿失禁治疗的效果。检验以下假设：盆底肌训练单独使用或与辅助疗法联合使用的证据是什么？不同类型盆底肌训练的证据是什么？盆底肌训练的治疗时长和次数是多少？
[已校正]研究类型：纳入随机对照试验和半随机研究。检索MEDLINE、PUBMED、COCHRANE、PEDro和SCOPUS中1999年至2009年发表的综述文章。
所有基于症状、体征或尿动力学评估诊断为压力性尿失禁的女性。排除其他形式的对照临床试验，例如那些症状可能由尿路以外的重要因素（神经疾病、认知障碍、缺乏独立活动能力）引起的试验。
盆底肌训练被定义为重复进行自愿性盆底肌收缩的方案，且有或没有医护人员监督。如果至少有一组采用盆底肌训练方案，单独使用或与其他辅助疗法（生物反馈、电刺激或阴道哑铃）联合使用，并与对照组进行比较，则所有研究均符合纳入标准。
感兴趣的结局包括症状治愈和治愈/改善；症状和特定疾病的生活质量评估、漏尿发作次数的量化；盆底肌收缩的测量。
19项研究符合纳入标准。该综述从高质量随机对照试验中发现了一致的证据，即盆底肌训练单独使用或与辅助疗法（生物反馈和电刺激）联合使用，对压力性尿失禁女性是有效的治疗方法，“治愈”和“治愈/改善”的比例分别高达70%和97%。
基于现有的少量数据，有强有力的证据表明物理治疗对女性压力性尿失禁的治疗有效，但需要进一步研究来评估最佳训练方案和治疗时长。
