Li Mengzhen, Qiu Kexin, Guo Haoran, Fan Mengsi, Yan Li
School of Public Health, Shandong Second Medical University, Weifang, China.
Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
Front Med (Lausanne). 2024 Dec 4;11:1517962. doi: 10.3389/fmed.2024.1517962. eCollection 2024.
This study aimed to compare the effectiveness of various conservative treatment strategies for women with stress urinary incontinence.
A comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library was conducted from their inception through March 2024, without restrictions on language or location. Randomized controlled trials (RCTs) comparing the efficacy of conservative treatments for stress urinary incontinence, using short-term pad test or the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score as outcome measures, were included. We conducted a network meta-analysis using a random-effects model to compare the effectiveness of different conservative treatment strategies, employing prediction interval plots and league tables, and ranked them according to the surface under the cumulative ranking curve (SUCRA). The quality of the included studies was assessed following the Cochrane Handbook for Systematic Reviews of Interventions.
A total of 31 RCTs involving 1,900 patients across 8 intervention categories were included in the analysis. SUCRA rankings indicated that electrical stimulation (SUCRA = 95.9%) was the most effective therapy for improving ICIQ-UI SF scores, followed by biofeedback electrical stimulation (SUCRA = 84.9%), radiofrequency (SUCRA = 77.5%), biofeedback (SUCRA = 57.8%), magnetic stimulation (SUCRA = 45.3%), pelvic floor muscle training (SUCRA = 38.4%), Er: YAG laser (SUCRA = 37.4%), and CO laser (SUCRA = 7.4%). In terms of reducing urine leakage, the treatments were ranked in descending order as follows: Er: YAG laser (SUCRA = 97.5%), biofeedback electrical stimulation (SUCRA = 83.4%), biofeedback (SUCRA = 67.0%), radiofrequency (SUCRA = 59.5%), electrical stimulation (SUCRA = 48.4%), pelvic floor muscle training (SUCRA = 43.0%), magnetic stimulation (SUCRA = 27.8%), and CO laser (SUCRA = 21.4%). Based on the clustered rankings of the two metrics, biofeedback electrical stimulation was identified as the most effective therapy for improving stress urinary incontinence.
Based on the combined analysis of two indicators, we found that biofeedback electrical stimulation may be the optimal therapy for the conservative management of stress urinary incontinence.
https://www.crd.york.ac.uk/prospero/, identifier CRD42024569845.
本研究旨在比较压力性尿失禁女性各种保守治疗策略的有效性。
对PubMed、科学网、Embase和考克兰图书馆进行全面检索，检索时间从各数据库建库起至2024年3月，不限语言和地区。纳入以短期护垫试验或国际尿失禁咨询问卷-尿失禁简表（ICIQ-UI SF）评分作为结局指标，比较压力性尿失禁保守治疗疗效的随机对照试验（RCT）。我们采用随机效应模型进行网状Meta分析，以比较不同保守治疗策略的有效性，使用预测区间图和联赛表，并根据累积排序曲线下面积（SUCRA）对其进行排序。按照《考克兰系统评价干预措施手册》评估纳入研究的质量。
分析共纳入31项RCT，涉及8种干预类别的1900例患者。SUCRA排名表明，电刺激（SUCRA = 95.9%）是改善ICIQ-UI SF评分最有效的治疗方法，其次是生物反馈电刺激（SUCRA = 84.9%）、射频（SUCRA = 77.5%）、生物反馈（SUCRA = 57.8%）、磁刺激（SUCRA = 45.3%）、盆底肌训练（SUCRA = 38.4%）、铒激光（SUCRA = 37.4%）和二氧化碳激光（SUCRA = 7.4%）。在减少漏尿方面，治疗方法按降序排列如下：铒激光（SUCRA = 97.5%）、生物反馈电刺激（SUCRA = 83.4%）、生物反馈（SUCRA = 67.0%）、射频（SUCRA = 59.5%）、电刺激（SUCRA = 48.4%）、盆底肌训练（SUCRA = 43.0%）、磁刺激（SUCRA = 27.8%）和二氧化碳激光（SUCRA = 21.4%）。基于这两个指标的聚类排名，生物反馈电刺激被确定为改善压力性尿失禁最有效的治疗方法。
基于对两个指标的综合分析，我们发现生物反馈电刺激可能是压力性尿失禁保守治疗的最佳疗法。
