Riemsma Rob, Hagen Suzanne, Kirschner-Hermanns Ruth, Norton Christine, Wijk Helle, Andersson Karl-Erik, Chapple Christopher, Spinks Julian, Wagg Adrian, Hutt Edward, Misso Kate, Deshpande Sohan, Kleijnen Jos, Milsom Ian
Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK.
NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
BMC Med. 2017 Mar 24;15(1):63. doi: 10.1186/s12916-017-0828-2.
Incontinence constitutes a major health problem affecting millions of people worldwide. The present study aims to assess cure rates from treating urinary (UI) or fecal incontinence (FI) and the number of people who may remain dependent on containment strategies.
Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and PEDro were searched from January 2005 to June 2015. Supplementary searches included conference abstracts and trials registers (2013-2015). Included studies had patients ≥ 18 years with UI or FI, reported treatment cure or success rates, had ≥ 50 patients treated with any intervention recognized in international guideline algorithms, a follow-up ≥ 3 months, and were published from 2005 onwards. Title and abstract screening, full paper screening, data extraction and risk-of-bias assessment were performed independently by two reviewers. Disagreements were resolved through discussion or referral to a third reviewer where necessary. A narrative summary of included studies is presented.
Most evidence was found for UI: Surgical interventions for stress UI showed a median cure rate of 82.3% (interquartile range (IQR), 72-89.5%); people with urgency UI were mostly treated using medications (median cure rate for antimuscarinics = 49%; IQR, 35.6-58%). Pelvic floor muscle training and bulking agents showed lower cure rates for UI. Sacral neuromodulation for FI had a median cure rate of 38.6% (IQR, 35.6-40.6%).
Many individuals were not cured and hence may continue to rely on containment. No studies were found assessing success of containment strategies. There was a lack of data in the disabled and in those with neurological diseases, in the elderly and those with cognitive impairment. Surgical interventions were effective for stress UI. Other interventions for UI and FI showed lower cure rates. Many individuals are likely to be reliant on containment strategies.
PROSPERO registration number: CRD42015023763 .
尿失禁是一个影响全球数百万人的主要健康问题。本研究旨在评估治疗尿失禁（UI）或粪失禁（FI）的治愈率以及可能仍依赖于防护策略的人数。
检索了2005年1月至2015年6月的Medline、Embase、PsycINFO、Cochrane对照试验中央注册库（CENTRAL）、CINAHL和PEDro。补充检索包括会议摘要和试验注册库（2013 - 2015年）。纳入的研究要求患者年龄≥18岁，患有UI或FI，报告治疗治愈率或成功率，接受国际指南算法中认可的任何干预措施治疗的患者≥50例，随访时间≥3个月，且发表于2005年以后。由两名 reviewers 独立进行标题和摘要筛选、全文筛选、数据提取和偏倚风险评估。如有分歧，通过讨论解决，必要时转介给第三位 reviewer。对纳入的研究进行了叙述性总结。
关于UI的证据最多：压力性UI的手术干预显示中位治愈率为82.3%（四分位间距（IQR），72 - 89.5%）；急迫性UI患者大多使用药物治疗（抗胆碱能药物的中位治愈率 = 49%；IQR，35.6 - 58%）。盆底肌肉训练和填充剂对UI的治愈率较低。骶神经调节治疗FI的中位治愈率为38.6%（IQR，35.6 - 40.6%）。
许多患者未治愈，因此可能继续依赖防护措施。未发现评估防护策略成功率的研究。在残疾人和神经疾病患者、老年人以及认知障碍患者中缺乏数据。手术干预对压力性UI有效。其他针对UI和FI的干预措施治愈率较低。许多人可能依赖防护策略。
PROSPERO注册：PROSPERO注册号：CRD42015023763 。
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