Berghmans L C, Hendriks H J, Bo K, Hay-Smith E J, de Bie R A, van Waalwijk van Doorn E S
Department of Urology, University Hospital Maastricht, The Netherlands.
Br J Urol. 1998 Aug;82(2):181-91. doi: 10.1046/j.1464-410x.1998.00730.x.
To assess the efficacy of physical therapies for first-line use in the treatment and prevention of stress urinary incontinence (SUI) in women, using a systematic review of randomized clinical trials (RCTs).
A computer-aided and manual search for published RCTs investigating treatment and prevention of SUI using physical therapies, e.g. pelvic floor muscle (PFM) exercises, with or without other treatment modalities, were carried out. The methodological quality of the included trials was assessed using criteria based on generally accepted principles of interventional research.
Twenty-four RCTs (22 treatment and two prevention) were identified; the methodological quality of the studies included was moderate and 11 RCTs were of sufficient quality to be included in further analysis. Based on levels-of-evidence criteria, there is strong evidence to suggest that PFM exercises are effective in reducing the symptoms of SUI. There is limited evidence for the efficacy of high-intensity vs a low-intensity regimen of PFM exercises. Despite significant effects of biofeedback after testing as an adjunct to PFM exercises, there is no evidence that PFM exercises with biofeedback are more effective than PFM exercises alone. There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, but when the results are combined there is strong evidence to suggest that electrostimulation is superior to sham electrostimulation, and limited evidence that there is no difference between electrostimulation and other physical therapies. In the prevention of SUI the efficacy of PFM exercises, with or without other adjuncts, is uncertain.
通过对随机临床试验（RCT）进行系统评价，评估物理疗法一线用于治疗和预防女性压力性尿失禁（SUI）的疗效。
通过计算机辅助和手工检索已发表的RCT，这些研究调查了使用物理疗法（如盆底肌（PFM）锻炼，无论是否联合其他治疗方式）治疗和预防SUI的情况。采用基于干预性研究普遍接受原则的标准评估纳入试验的方法学质量。
共识别出24项RCT（22项治疗研究和2项预防研究）；纳入研究的方法学质量中等，11项RCT质量足够高可纳入进一步分析。基于证据水平标准，有充分证据表明PFM锻炼可有效减轻SUI症状。关于高强度与低强度PFM锻炼方案疗效的证据有限。尽管生物反馈作为PFM锻炼的辅助手段在测试后有显著效果，但没有证据表明联合生物反馈的PFM锻炼比单纯PFM锻炼更有效。电刺激研究在（刺激类型和参数方面）几乎没有一致性，但综合结果时有充分证据表明电刺激优于假电刺激，且有有限证据表明电刺激与其他物理疗法之间无差异。在预防SUI方面，无论是否联合其他辅助手段，PFM锻炼的疗效均不确定。
