非手术、微创或无创疗法对神经源性膀胱所致尿失禁的影响：一项系统评价和荟萃分析
Effects of nonsurgical, minimally or noninvasive therapies for urinary incontinence due to neurogenic bladder: a systematic review and meta-analysis.
作者信息
Ali Mohammed Usman, Fong Kenneth Nai-Kuen, Kannan Priya, Bello Umar Muhammad, Kranz Georg
机构信息
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong Department of Medical Rehabilitation (Physiotherapy), University of Maiduguri, Maiduguri, Nigeria.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
出版信息
Ther Adv Chronic Dis. 2022 Mar 18;13:20406223211063059. doi: 10.1177/20406223211063059. eCollection 2022.
OBJECTIVE
To determine the effects of nonsurgical, minimally or noninvasive therapies on urge urinary incontinence (UUI) symptoms and quality of life (QoL) in individuals with neurogenic bladder (NGB).
DATA SOURCES
Cochrane library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science databases were searched from inception to September 2021.
REVIEW METHODS
Randomized controlled trials that compared therapies such as intravaginal electrical stimulation (IVES), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), transcutaneous tibial nerve stimulation (TTNS), pelvic floor muscle training (PFMT), and behavioural therapy (BT) to control were included. Study screening, data extraction, and study quality assessments were performed by two independent authors.
RESULTS
Fourteen trials with 804 participants were included in the study after screening of 4281 potentially relevant articles. Meta-analyses revealed a significant effect of electrical stimulation on UUI due to multiple sclerosis (standardized mean difference (SMD): -0.614; 95% confidence interval (CI): -1.023, -0.206; = 0.003) and stroke (SMD: -2.639; 95% CI: -3.804, -1.474; = 0.000). The pooled analyses of TTNS (weighted mean difference (WMD): -12.406; 95% CI: -16.015, -8.797; = 0.000) and BT (WMD: -9.117; 95% CI: -14.746, -3.487; = 0.002) revealed significant effects of these interventions on QoL in people with Parkinson's disease. However, meta-analyses revealed nonsignificant effects for PFMT (WMD: -0.751; 95% CI: -2.426, 0.924; = 0.380) and BT (WMD: -0.597; 95% CI: -1.278, 0.083; = 0.085) on UUI due to Parkinson's disease.
CONCLUSIONS
Our meta-analyses found electrical stimulation to be beneficial for improving the symptoms of UUI among people with multiple sclerosis and those with stroke. Our review also revealed that TTNS and BT might improve QoL for people with NGB due to Parkinson's disease, although the effects of PFMT and BT on UUI warrant further investigation.
目的
确定非手术、微创或无创疗法对神经源性膀胱（NGB）患者急迫性尿失禁（UUI）症状和生活质量（QoL）的影响。
数据来源
检索Cochrane图书馆、EMBASE、MEDLINE、PEDro、Scopus和Web of Science数据库，检索时间从建库至2021年9月。
综述方法
纳入比较阴道内电刺激（IVES）、经皮电神经刺激（TENS）、神经肌肉电刺激（NMES）、经皮胫神经刺激（TTNS）、盆底肌训练（PFMT）和行为疗法（BT）等疗法与对照的随机对照试验。由两名独立作者进行研究筛选、数据提取和研究质量评估。
结果
在筛选了4281篇潜在相关文章后，该研究纳入了14项试验，共804名参与者。荟萃分析显示，电刺激对多发性硬化症导致的UUI有显著效果（标准化均数差（SMD）：-0.614；95%置信区间（CI）：-1.023，-0.206；P = 0.003），对中风导致的UUI也有显著效果（SMD：-2.639；95%CI：-3.804，-1.474；P = 0.000）。TTNS（加权均数差（WMD）：-12.406；95%CI：-16.015，-8.797；P = 0.000）和BT（WMD：-9.117；95%CI：-14.746，-3.487；P = 0.002）的汇总分析显示，这些干预措施对帕金森病患者的生活质量有显著影响。然而，荟萃分析显示，PFMT（WMD：-0.751；95%CI：-2.426，0.924；P = 0.380）和BT（WMD：-0.597；95%CI：-1.278，0.083；P = 0.085）对帕金森病导致的UUI无显著影响。
结论
我们的荟萃分析发现，电刺激有利于改善多发性硬化症患者和中风患者的UUI症状。我们的综述还显示，TTNS和BT可能改善帕金森病导致的NGB患者的生活质量，尽管PFMT和BT对UUI的影响有待进一步研究。
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