Matsuoka Priscila Katsumi, Locali Rafael Fagionato, Pacetta Aparecida Maria, Baracat Edmund Chada, Haddad Jorge Milhem
Disciplina de Ginecologia, Divisão de Uroginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo/SP, Brazil.
Disciplina de Urologia, Departamento de Cirurgia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo/, SP, Brazil.
Clinics (Sao Paulo). 2016 Feb;71(2):94-100. doi: 10.6061/clinics/2016(02)08.
To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.
为评估不同填充剂治疗女性尿失禁的疗效和安全性，进行了一项仅纳入随机对照试验的系统评价。研究对象为尿失禁女性。主要结局为临床和尿动力学参数。结果以非连续变量的加权平均差和连续变量的相对风险表示，并均给出95%置信区间。最初识别出942项研究。然而，只有14项符合条件的试验满足前提条件。该评价共纳入了八项不同类型填充剂试验中的1814例患者，并对所有研究进行了描述和分析。使用了多种工具对测量的结局进行评估。填充剂最常见的并发症为尿潴留和尿路感染。此外，还出现了某些严重并发症，如使用自体脂肪后有1例死亡。然而，研究数量不足、研究人群异质性、所用材料种类繁多以及缺乏长期随访限制了实践指导。为确定哪种物质最合适，需要更多基于标准化临床结局比较现有填充剂的随机临床试验。
