CO激光疗法治疗女性压力性尿失禁：一项系统评价与荟萃分析
CO laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis.
作者信息
Hafidh Bandr, Baradwan Saeed, Latifah Hassan M, Gari Abdulrahim, Sabban Hussein, Abduljabbar Hanin Hassan, Tawfiq Afaf, Hakeem Ghaidaa Farouk, Alkaff Alya, Alzawawi Nabigah, Iskandarani Radiah, Khurshid Kausar, Syed Kausar Aisha, Alkhiary Ammar Y, Bukhari Ibtihal Abdulaziz, Baalharith Maha Al, Abu-Zaid Ahmed
机构信息
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
出版信息
Ther Adv Urol. 2023 Nov 10;15:17562872231210216. doi: 10.1177/17562872231210216. eCollection 2023 Jan-Dec.
BACKGROUND
Carbon dioxide (CO) laser therapy is an emerging treatment for women with stress urinary incontinence (SUI).
OBJECTIVES
To examine the efficacy of CO laser therapy for management of SUI-related symptoms in women.
DESIGN
A systematic review and meta-analysis of randomized controlled trials and cohort studies.
DATA SOURCES AND METHODS
Four databases were screened until January 2023. All efficacy continuous endpoints were assessed subtraction of the posttreatment from pretreatment values. The data were summarized as mean difference (MD) with 95% confidence interval (CI) using the random-effects model.
RESULTS
A total of 15 studies with 700 patients were analyzed. CO laser therapy significantly decreased the 1-h pad weights at 3 months [ = 5 studies, MD = -3.656 g, 95% CI (-5.198, -2.113), < 0.001], 6 months [ = 6 studies, MD = -6.583 g, 95% CI (-11.158, -2.008), = 0.005], and 12 months [ = 6 studies, MD = -3.726 g, 95% CI (-6.347, -1.106), = 0.005]. Moreover, CO laser therapy significantly decreased the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form Scores at 3 months [ = 10 studies, MD = -4.805, 95% CI (-5.985, -3.626), < 0.001] and 12-months [ = 6 studies, MD = -3.726, 95% CI (-6.347, -1.106), = 0.005]. Additionally, CO laser therapy significantly decreased the Pelvic Floor Impact Questionnaire scores at 6 months [ = 2 studies, MD = -11.268, 95% CI (-18.671, -3.865), = 0.002] and 12 months [ = 2 studies, MD = -10.624, 95% CI (-18.145, -3.103), = 0.006]. Besides, CO laser therapy significantly decreased the Urogenital Distress Inventory-6 scores at 3 months [ = 2 studies, MD = -21.997, 95% CI (-32.294, -11.699), < 0.001], but not at 6 months [ = 3 studies, MD = -3.034, 95% CI (-7.357, 1.259), = 0.169]. Lastly, CO laser therapy significantly increased the Vaginal Health Index Score at 6 months [ = 2 studies, MD = 2.826, 95% CI (0.013, 5.638), = 0.047] and 12 months [MD = 1.553, 95% CI (0.173, 2.934), = 0.027].
CONCLUSION
CO laser therapy improved the SUI-related symptoms in women. To obtain solid conclusions, future studies should be well-designed with standardized settings, consistent therapeutic protocols, and long-term follow-up periods.
背景
二氧化碳（CO）激光疗法是一种用于治疗女性压力性尿失禁（SUI）的新兴疗法。
目的
研究CO激光疗法对女性SUI相关症状的治疗效果。
设计
对随机对照试验和队列研究进行系统评价和荟萃分析。
数据来源与方法
检索了四个数据库直至2023年1月。所有疗效连续性终点均通过预处理值减去治疗后值进行评估。使用随机效应模型将数据汇总为平均差（MD）及95%置信区间（CI）。
结果
共分析了15项研究，涉及700例患者。CO激光疗法在3个月时显著降低了1小时护垫重量[=5项研究，MD=-3.656g，95%CI（-5.198，-2.113），<0.001]，6个月时[=6项研究，MD=-6.583g，95%CI（-11.158，-2.008），=0.005]，以及12个月时[=6项研究，MD=-3.726g，95%CI（-6.347，-1.106），=0.005]。此外，CO激光疗法在3个月时显著降低了国际尿失禁咨询问卷-尿失禁简表评分[=10项研究，MD=-4.805，95%CI（-5.985，-3.626），<0.001]和12个月时[=6项研究，MD=-3.726，95%CI（-6.347，-1.106），=0.005]。另外，CO激光疗法在6个月时显著降低了盆底影响问卷评分[=2项研究，MD=-11.268，95%CI（-18.671，-3.865），=0.002]和12个月时[=2项研究，MD=-10.624，95%CI（-18.145，-3.103），=0.006]。此外，CO激光疗法在3个月时显著降低了泌尿生殖系统困扰量表-6评分[=2项研究，MD=-21.997，95%CI（-32.294，-11.699），<0.001]，但在6个月时未降低[=3项研究，MD=-3.034，95%CI（-7.357，1.259），=0.169]。最后，CO激光疗法在6个月时显著提高了阴道健康指数评分[=2项研究，MD=2.826，95%CI（0.013，5.638），=0.047]和12个月时[MD=1.553，95%CI（0.173，2.934），=0.027]。
结论
CO激光疗法改善了女性的SUI相关症状。为得出确凿结论，未来的研究应精心设计，具备标准化设置、一致的治疗方案和长期随访期。
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