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Mechanical devices for urinary incontinence in women.

Abstract

BACKGROUND

Incontinence can have a devastating effect on the lives of sufferers with significant economic implications. Non-surgical treatments such as pelvic floor muscle training and the use of mechanical devices are usually the first line of management, particularly when a woman does not want surgery or when she is considered unfit for surgery. Mechanical devices are inexpensive and do not compromise future surgical treatment.

OBJECTIVES

To determine whether mechanical devices are useful in the management of adult female urinary incontinence.

SEARCH METHODS

For this second update we searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 21 August 2014), EMBASE (January 1947 to 2014 Week 34), CINAHL (January 1982 to 25 August 2014), and the reference lists of relevant articles.

SELECTION CRITERIA

All randomised or quasi-randomised controlled trials of mechanical devices in the management of adult female urinary incontinence determined by symptom, sign or urodynamic diagnosis.

DATA COLLECTION AND ANALYSIS

The reviewers assessed the identified studies for eligibility and risk of bias and independently extracted data from the included studies. Data analysis was performed using RevMan software (version 5.3).

MAIN RESULTS

One new trial was identified and included in this update bringing the total to eight trials involving 787 women. Three small trials compared a mechanical device with no treatment and although they suggested that use of a mechanical device might be better than no treatment, the evidence for this was inconclusive. Four trials compared one mechanical device with another. Quantitative synthesis of data from these trials was not possible because different mechanical devices were compared in each trial using different outcome measures. Data from the individual trials showed no clear difference between devices, but with wide confidence intervals. One trial compared three groups: a mechanical device alone, behavioural therapy (pelvic floor muscle training) alone and behavioural therapy combined with a mechanical device. While at three months there were more withdrawals from the device-only group, at 12 months differences between the groups were not sustained on any measure.

AUTHORS' CONCLUSIONS

The place of mechanical devices in the management of urinary incontinence remains in question. Currently there is little evidence from controlled trials on which to judge whether their use is better than no treatment and large well-conducted trials are required for clarification. There was also insufficient evidence in favour of one device over another and little evidence to compare mechanical devices with other forms of treatment.

Authors+Show Affiliations

Faculty of Life Sciences and Education, School of Care Sciences, University of South Wales, Glyn Taff Campus, Pontypridd, Rhondda Cynon Taff, CF37 4BD, UK. allyson.lipp@southwales.ac.uk.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

25517397

Citation

Lipp, Allyson, et al. "Mechanical Devices for Urinary Incontinence in Women." The Cochrane Database of Systematic Reviews, 2014, p. CD001756.
Lipp A, Shaw C, Glavind K. Mechanical devices for urinary incontinence in women. Cochrane Database Syst Rev. 2014.
Lipp, A., Shaw, C., & Glavind, K. (2014). Mechanical devices for urinary incontinence in women. The Cochrane Database of Systematic Reviews, (12), CD001756. https://doi.org/10.1002/14651858.CD001756.pub6
Lipp A, Shaw C, Glavind K. Mechanical Devices for Urinary Incontinence in Women. Cochrane Database Syst Rev. 2014 Dec 17;(12)CD001756. PubMed PMID: 25517397.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mechanical devices for urinary incontinence in women. AU - Lipp,Allyson, AU - Shaw,Christine, AU - Glavind,Karin, Y1 - 2014/12/17/ PY - 2014/12/18/entrez PY - 2014/12/18/pubmed PY - 2015/1/30/medline SP - CD001756 EP - CD001756 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 12 N2 - BACKGROUND: Incontinence can have a devastating effect on the lives of sufferers with significant economic implications. Non-surgical treatments such as pelvic floor muscle training and the use of mechanical devices are usually the first line of management, particularly when a woman does not want surgery or when she is considered unfit for surgery. Mechanical devices are inexpensive and do not compromise future surgical treatment. OBJECTIVES: To determine whether mechanical devices are useful in the management of adult female urinary incontinence. SEARCH METHODS: For this second update we searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 21 August 2014), EMBASE (January 1947 to 2014 Week 34), CINAHL (January 1982 to 25 August 2014), and the reference lists of relevant articles. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials of mechanical devices in the management of adult female urinary incontinence determined by symptom, sign or urodynamic diagnosis. DATA COLLECTION AND ANALYSIS: The reviewers assessed the identified studies for eligibility and risk of bias and independently extracted data from the included studies. Data analysis was performed using RevMan software (version 5.3). MAIN RESULTS: One new trial was identified and included in this update bringing the total to eight trials involving 787 women. Three small trials compared a mechanical device with no treatment and although they suggested that use of a mechanical device might be better than no treatment, the evidence for this was inconclusive. Four trials compared one mechanical device with another. Quantitative synthesis of data from these trials was not possible because different mechanical devices were compared in each trial using different outcome measures. Data from the individual trials showed no clear difference between devices, but with wide confidence intervals. One trial compared three groups: a mechanical device alone, behavioural therapy (pelvic floor muscle training) alone and behavioural therapy combined with a mechanical device. While at three months there were more withdrawals from the device-only group, at 12 months differences between the groups were not sustained on any measure. AUTHORS' CONCLUSIONS: The place of mechanical devices in the management of urinary incontinence remains in question. Currently there is little evidence from controlled trials on which to judge whether their use is better than no treatment and large well-conducted trials are required for clarification. There was also insufficient evidence in favour of one device over another and little evidence to compare mechanical devices with other forms of treatment. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/25517397/Mechanical_devices_for_urinary_incontinence_in_women_ L2 - https://doi.org/10.1002/14651858.CD001756.pub6 DB - PRIME DP - Unbound Medicine ER -