Conservative treatments for women with stress urinary incontinence: a systematic review and network meta-analysis

Mengzhen Li; Kexin Qiu; Haoran Guo; Mengsi Fan; Li Yan

doi:10.3389/fmed.2024.1517962

Conservative treatments for women with stress urinary incontinence: a systematic review and network meta-analysis

Front Med (Lausanne). 2024 Dec 4:11:1517962. doi: 10.3389/fmed.2024.1517962. eCollection 2024.

Authors

Mengzhen Li^{1

2}, Kexin Qiu^{1

2}, Haoran Guo^{1

2}, Mengsi Fan^{1

2}, Li Yan^{2

3}

Affiliations

¹ School of Public Health, Shandong Second Medical University, Weifang, China.
² 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.
³ Department of Gynecology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.

Abstract

Objective: This study aimed to compare the effectiveness of various conservative treatment strategies for women with stress urinary incontinence.

Methods: 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.

Results: 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 CO₂ 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 CO₂ 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.

Conclusion: 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.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024569845.

Keywords: biofeedback electrical stimulation; conservative treatment; laser; network meta-analysis; stress urinary incontinence.

Publication types

Systematic Review

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This research was supported by the Project of the Research Hospital Association of Shandong Province (2022001).