Han Xu, Shen Haiyue, Chen Jiming, Wu Yi
The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.
Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Int Urogynecol J. 2022 Apr;33(4):789-799. doi: 10.1007/s00192-021-04928-2. Epub 2021 Aug 17.
This systematic review and meta-analysis was aimed at investigating the safety and short- and long-term efficacy of electrical stimulation (ES) in women with stress urinary incontinence (SUI).
PubMed, Embase, and the Cochrane database were searched for randomized controlled trials (RCTs) conducted up to 2020. Studies comparing ES with sham ES or no intervention were included. Standardized mean differences (SMDs), weighted mean differences (WMDs), relative risks (RR), and 95% confidence intervals (CIs) were calculated.
This study included 9 RCTs, involving a total of 982 patients, of whom 520 received ES. Our results showed that in the short term (< 3 months), compared with sham ES or no intervention, ES significantly improved incontinence-specific quality of life (IQOL) (p = 0.003; SMD = 0.90 [95% CI, 0.30 to 1.50]; I = 88%) and reduced urine leakage (p < 0.00001; WMD = -6.15 [95% CI, -8.29 to -4.01]; I = 0%) but did not significantly reduce the frequency of incontinence episodes (p = 0.34; WMD = -0.98 [95% CI, -2.99 to 1.04]; I = 85%). In the long term (3-7.5 months), ES significantly improved IQOL (p = 0.0009; SMD = 1.14 [95% CI, 0.47 to 1.81]; I = 91%) and reduced the frequency of incontinence episodes (p = 0.0009; WMD = -2.45 [95% CI, -3.90 to -1.01]; I = 79%) but did not significantly reduce urine leakage (p = 0.27; WMD = -9.21 [95% CI, -25.57 to 7.14]; I = 71%). There was no significant difference in adverse events between ES and sham ES or no intervention (p = 0.36; RR = 1.34 [95% CI, 0.72 to 2.50]; I = 0%). A test for subgroup differences showed that electroacupuncture (EA) improved long-term IQOL to a greater extent than vaginal ES (VES), whereas there was no significant difference in efficacy between EA and VES in short- or long-term reduction of urine leakage, frequency of incontinence episodes, or short-term IQOL improvement.
ES may improve short- and long-term IQOL for women with SUI, but it appears to provide only short-term reduction in urine leakage and long-term reduction in frequency of incontinence episodes. However, we cannot draw any conclusion on the safety between ES and sham ES or no intervention because of the rarity of adverse events. It is still uncertain whether EA is comparable or superior to VES owing to an insufficient number of studies and patients. The conclusions should be considered carefully because of the limited quality and quantity of the RCTs included. Further rigorous RCTs with adequate sample sizes and long follow-up are necessary to fully validate our findings.
本系统评价和荟萃分析旨在研究电刺激（ES）治疗压力性尿失禁（SUI）女性的安全性及短期和长期疗效。
检索了PubMed、Embase和Cochrane数据库中截至2020年开展的随机对照试验（RCT）。纳入比较ES与假电刺激或无干预措施的研究。计算标准化均数差（SMD）、加权均数差（WMD）、相对危险度（RR）及95%置信区间（CI）。
本研究纳入9项RCT，共982例患者，其中520例接受ES治疗。结果显示，短期内（<3个月），与假电刺激或无干预措施相比，ES显著改善了尿失禁特异性生活质量（IQOL）（p = 0.003；SMD = 0.90 [95%CI，0.30至1.50]；I² = 88%），并减少了漏尿（p < 0.00001；WMD = -6.15 [95%CI，-8.29至-4.01]；I² = 0%），但未显著降低尿失禁发作频率（p = 0.34；WMD = -0.98 [95%CI，-2.99至1.04]；I² = 85%）。长期内（3 - 7.5个月），ES显著改善了IQOL（p = 0.0009；SMD = 1.14 [95%CI，0.47至1.81]；I² = 91%），并降低了尿失禁发作频率（p = 0.0009；WMD = -2.45 [95%CI，-3.90至-1.01]；I² = 79%），但未显著减少漏尿（p = 0.27；WMD = -9.21 [95%CI，-25.57至7.14]；I² = 71%）。ES与假电刺激或无干预措施在不良事件方面无显著差异（p = 0.36；RR = 1.34 [95%CI，0.72至2.50]；I² = 0%）。亚组差异检验显示，电针（EA）在改善长期IQOL方面比阴道电刺激（VES）更显著，而在短期或长期减少漏尿、尿失禁发作频率或改善短期IQOL方面，EA与VES的疗效无显著差异。
ES可能改善SUI女性的短期和长期IQOL，但似乎仅能短期减少漏尿，长期降低尿失禁发作频率。然而，由于不良事件罕见，我们无法就ES与假电刺激或无干预措施的安全性得出任何结论。由于研究和患者数量不足，EA是否与VES相当或更优仍不确定。鉴于纳入的RCT质量和数量有限，应谨慎考虑这些结论。需要进一步开展样本量充足且随访时间长的严格RCT，以充分验证我们的研究结果。
