Center Hospitalier Regional d'Orléans, Departement of Gynecologic Surgery, 14 Avenue de L'hôpital, 45100 Orleans, France.
EUKCVL, Université d'Orléans, 45100 Orleans, France.
Int J Environ Res Public Health. 2022 Feb 27;19(5):2789. doi: 10.3390/ijerph19052789.
To determine the effectiveness of pelvic floor muscle training (PFMT) with or without biofeedback or electrostimulation in reducing urinary incontinence and pelvic floor muscle con-traction in non-pregnant women with urinary incontinence.
The following electronic databases were searched: PubMed, Cochrane Central, ClinicalTrials.gov, EU Clinical Trials Register, and sources from NICE, FDA, EMA, and SMC (articles only in English, 2000-2021). Search terms were: urinary incontinence, pelvic floor muscle training or exercises, biofeedback, electrostimulation. We used the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for this systematic review. Relevant articles were selected, data were extracted, and quality was assessed. Data were extracted in predesigned form, followed by narrative synthesis.
Following the search, 15 RCTs were retrieved using the strict inclusion and exclusion criteria, assessing 2441 non-pregnant women with urinary incontinence. Of the 15 studies, 7 were low risk, 5 were medium risk, and 3 were high-risk studies. Of the 2441 patients, 970 were in PFMT, 69 were in extracorporeal magnetic innervation (ExMi) or with PFMT + BF, 30 were in electrostimulation (ES), 21 were in whole body vibration training (WBVT), 23 were in pelvic floor muscle + abdominal muscle therapy (PFM + AMT), 326 were in PFMT + biofeedback, 93 were in vaginal cones (VC), 362 were in PFMT + education, 318 were in education, and 229 were in control groups. The most often measures employed were pad tests, bladder diary, and questionnaire on the quality of life. Stress, urge and mixed urinary incontinence were studied. In all RCT, PFMT significantly reduced urinary incontinence, essentially SIU and MUI, when compared with the control group before and after treatment. Overall, out of 997 PFMT or PFMT + education patients, 504 patients (50.5%) showed improvement in urinary incontinence, and 218 became continent (21.8%) (negative pad test). In total, 62% of patients significantly reduced their urinary incontinence or cured it and improved their pelvic floor muscle contraction. All other physiotherapist techniques also significantly reduced urinary leakages, e.g., vaginal cones, biofeedback, ExMI, and WBVT when compared with the control group. There were no significant differences between these methods in reducing the severity of urinary incontinence.
PFMT alone or with bio-feedback or electrostimulation was effective in reducing urinary incontinence and improving pelvic floor muscle contraction. PFMT when compared with other interventions such as bio-feedback, VC, and WBVT did not show significant differences but was superior to the control group. RCT studies with similar parameters used for measuring the outcomes need to be included.
确定在非妊娠尿失禁女性中，单独进行或联合使用盆底肌训练（pelvic floor muscle training，PFMT）、生物反馈或电刺激对减少尿失禁和改善盆底肌收缩的效果。
检索了以下电子数据库：PubMed、Cochrane 中央、ClinicalTrials.gov、欧盟临床试验注册处，以及 NICE、FDA、EMA 和 SMC 的来源（仅收录英文文献，时间范围 2000 年至 2021 年）。检索词包括：尿失禁、盆底肌训练或锻炼、生物反馈、电刺激。我们使用 PRISMA 声明（系统评价和荟萃分析的首选报告项目）进行了这项系统综述。选择了相关文章，提取数据并评估了质量。数据以预先设计的表格形式提取，然后进行叙述性综合。
根据严格的纳入和排除标准，搜索后共检索到 15 项 RCT，共纳入 2441 名非妊娠尿失禁女性。15 项研究中，7 项为低风险，5 项为中风险，3 项为高风险研究。2441 名患者中，970 名接受了 PFMT，69 名接受了体外磁神经刺激（extracorporeal magnetic innervation，ExMi）或 PFMT+生物反馈，30 名接受了电刺激（electrostimulation，ES），21 名接受了全身振动训练（whole body vibration training，WBVT），23 名接受了盆底肌+腹肌治疗（pelvic floor muscle+abdominal muscle therapy，PFM+AMT），326 名接受了 PFMT+生物反馈，93 名接受了阴道球（vaginl cones，VC），362 名接受了 PFMT+教育，318 名接受了教育，229 名接受了对照组。最常使用的措施包括垫试验、膀胱日记和生活质量问卷。研究了压力性、急迫性和混合性尿失禁。在所有 RCT 中，PFMT 在治疗前后均显著减少了尿失禁，尤其是压力性和混合性尿失禁，与对照组相比。总的来说，在 997 名接受 PFMT 或 PFMT+教育的患者中，504 名（50.5%）患者的尿失禁得到改善，218 名患者（21.8%）治愈（垫试验阴性）。总的来说，62%的患者显著减少了尿失禁或治愈了尿失禁，并改善了盆底肌收缩。所有其他物理治疗技术，如阴道球、生物反馈、ExMi 和 WBVT，与对照组相比，也显著减少了尿漏。在减轻尿失禁严重程度方面，这些方法之间没有显著差异。
单独进行或联合使用生物反馈或电刺激的 PFMT 可有效减少尿失禁并改善盆底肌收缩。与其他干预措施（如生物反馈、阴道球和 WBVT）相比，PFMT 与对照组相比没有显著差异，但优于对照组。需要纳入具有类似参数的 RCT 研究来评估治疗效果。
