Oblasser Claudia, Christie Janice, McCourt Christine
School of Health Sciences, Centre for Maternal and Child Health Research, Division of Midwifery and Radiography, City University London, 1 Myddelton Street, London EC1R 1UW, UK.
School of Health Sciences, Early Years Division, City University London, 1 Myddelton Street, London EC1R 1UW, UK.
Midwifery. 2015 Nov;31(11):1017-25. doi: 10.1016/j.midw.2015.08.011. Epub 2015 Sep 9.
the vaginal use of cones or balls aims to increase muscle performance and thereby prevent or treat urinary incontinence. To date, no systematic review has focused on the effectiveness of these devices specifically during the postpartum period. The objectives of this review were: to compare the effectiveness of vaginal cones or balls for improvement of pelvic floor muscle performance and urinary continence in the postpartum period to no treatment, placebo, sham treatment or active controls; to gather information on effect on perineal descent or pelvic organ prolapse, adverse effects and economical aspects.
quantitative systematic review.
14 scientific databases (including PubMed and CINAHL) and the world-wide web; experts were contacted for published and unpublished data.
studies had to be randomised/quasi-randomised trials and have female participants up to one year after childbirth. The intervention is compared to no treatment, placebo, sham treatment or active controls. Outcome measures relate to pelvic floor muscle performance or urinary incontinence. Studies were selected, 'risk of bias' assessed, and data extracted by two reviewers independently with inter-reviewer agreement.
one study met the inclusion criteria; its original data were re-analysed. In an intention-to-treat analysis, compared with the control group, the cone group showed a statistically significant lower rate of urinary incontinence; compared with the exercise group, the prevalence was similar. However, the validity of the analysis is limited.
the evidence gained from this systematic review is very limited. The use of cones may be helpful for urinary incontinence after childbirth, but further research is needed.
阴道使用球囊或球旨在提高肌肉功能，从而预防或治疗尿失禁。迄今为止，尚无系统评价专门关注这些器械在产后时期的有效性。本评价的目的是：比较产后时期阴道球囊或球在改善盆底肌肉功能和尿失禁方面与不治疗、安慰剂、假治疗或积极对照的有效性；收集有关对会阴下降或盆腔器官脱垂的影响以及不良反应和经济方面的信息。
定量系统评价。
14个科学数据库（包括PubMed和CINAHL）以及互联网；联系专家获取已发表和未发表的数据。
研究必须为随机/半随机试验，且研究对象为产后一年内的女性。将干预措施与不治疗、安慰剂、假治疗或积极对照进行比较。结局指标涉及盆底肌肉功能或尿失禁。由两名评价员独立选择研究、评估“偏倚风险”并提取数据，并达成评价员间的一致意见。
一项研究符合纳入标准；对其原始数据进行了重新分析。在意向性分析中，与对照组相比，球囊组尿失禁发生率在统计学上显著更低；与运动组相比，患病率相似。然而，该分析的有效性有限。
从该系统评价中获得的证据非常有限。使用球囊可能有助于产后尿失禁，但仍需进一步研究。
