Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women
Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women
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DOI：
10.1136/bmj.318.7182.487
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发表时间：
1999-02-20
影响因子：
105.7
通讯作者：
Holme, I
中科院分区：
文献类型：
--
作者：
Bo, K;Talseth, T;Holme, I
目的比较骨盆底运动、电刺激、阴道锥和不治疗对真性压力性尿失禁的效果。设计分层、单盲、随机对照试验。设置多中心。参与者107名经临床和尿动力学证实的真性压力性尿失禁妇女。平均（范围）年龄为49.5（24-70）岁，平均（范围）症状持续时间为10.8（1-45）years.Interventions骨盆底运动（n = 25）包括8-12收缩3次，每天和熟练的物理治疗师每周一次的组中的运动。电刺激组（n = 25）使用MS 106 Twin以50 Hz间歇刺激阴道30 min/d。阴道锥组（n = 27）每天使用锥20分钟。未治疗对照组（n = 30）提供了一个护目镜的使用。每月一次通过阴道挤压压力测量肌肉力量。主要结果测量标准化膀胱体积的Pad试验，和自我报告的严重程度。结果改善肌肉力量显着更大（P = 0.03）骨盆底运动后（19.2 cm H2O之前为11.0 cm H2O（95%置信区间为7.7至14.3））（15.3至23.1）后）比任何电刺激（14.8 cm H2O（10.9至18.7）v 18.6 cm H2O（13.3至23.9））或阴道锥体（11.8 cm H2O（8.5至15.1）v 15.4 cm H2O（11.1至19.7））。运动组（-30.2 g;-43.3至16.9）中垫上试验泄漏的减少大于电刺激组（-7.4 g;-20.9至6.1）和阴道锥组（-14.7 g;-27.6至1.8）。在完成试验的一个参与者在对照组中，14在骨盆底运动组，三个在电刺激组，和两个在阴道锥组不再认为自己有一个problem.Conclusion训练的骨盆底肌肉是上级电刺激和阴道锥在治疗真正的压力性尿失禁。
Objective To compare the effect of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment for genuine stress incontinence.Design Stratified, single blind, randomised controlled trial.Setting Multicentre.Participants 107 women with clinically and urodynamically proved genuine stress incontinence. Mean (range) age was 49.5 (24-70) years, and mean (range) duration of symptoms 10.8 (1-45) years.Interventions Pelvic floor exercise (n = 25) comprised 8-12 contractions 3 times a day and exercise in groups with skilled physical therapists once a week. The electrical stimulation group (n = 25) used vaginal intermittent stimulation with the MS 106 Twin at 50 Hz 30 minutes a day. The vaginal cones group (n = 27) used cones for 20 minutes a day. The untreated control group (n = 30) was offered the use of a continence guard. Muscle strength was measured by vaginal squeeze pressure once a month.Main outcome measures Pad test with standardised bladder volume, and self report of severity.Results Improvement in muscle strength was significantly greater (P = 0.03) after pelvic floor exercises (11.0 cm H2O (95% confidence interval 7.7 to 14.3) before v 19.2 cm H2O (15.3 to 23.1) after) than either electrical stimulation (14.8 cm H2O (10.9 to 18.7) v 18.6 cm H2O (13.3 to 23.9)) or vaginal cones (11.8 cm H2O (8.5 to 15.1)v 15.4 cm H2O (11.1 to 19.7)). Reduction in leakage on pad test was greater in the exercise group (- 30.2 g; - 43.3 to 16.9) than in the electrical stimulation group (- 7.4 g; - 20.9 to 6.1) and the vaginal cones group (- 14.7 g; - 27.6 to - 1.8). On completion of the trial one participant in the control group, 14 in the pelvic floor exercise group, three in the electrical stimulation group, and two in the vaginal cones group no longer considered themselves as having a problem.Conclusion Training of the pelvic floor muscles is superior to electrical stimulation and vaginal cones in the treatment of genuine stress incontinence.