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Electrical stimulation with non-implanted electrodes for urinary incontinence in men

  1. Bary Berghmans1,*,
  2. Erik Hendriks2,
  3. Arnold Bernards3,
  4. Rob de Bie2,
  5. Muhammad Imran Omar4

Editorial Group: Cochrane Incontinence Group

Published Online: 6 JUN 2013

Assessed as up-to-date: 21 JAN 2012

DOI: 10.1002/14651858.CD001202.pub5


How to Cite

Berghmans B, Hendriks E, Bernards A, de Bie R, Omar MI. Electrical stimulation with non-implanted electrodes for urinary incontinence in men. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD001202. DOI: 10.1002/14651858.CD001202.pub5.

Author Information

  1. 1

    Maastricht University Medical Centre, Pelvic care Center Maastricht, Maastricht, Netherlands

  2. 2

    Maastricht University, Department of Epidemiology, Maastricht, Netherlands

  3. 3

    Dutch Institute of Allied Health Care (Nederland Paramedisch Instituut: NPi), Research & Innovation, Amersfoort, Utrecht, Netherlands

  4. 4

    University of Aberdeen, Academic Urology Unit, Aberdeen, Scotland, UK

*Bary Berghmans, Pelvic care Center Maastricht, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 az, Netherlands. bary.berghmans@maastrichtuniversity.nl.

Publication History

  1. Publication Status: New
  2. Published Online: 6 JUN 2013

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Characteristics of included studies [ordered by study ID]
Ceresoli 2002

Methods2-arm Randomized Controlled Trial


ParticipantsParticipants underwent post-radical perineal prostatectomy for localized prostate cancer with post-operative (stress) incontinence

Age: not specified


InterventionsA (n=34): Daily Transcutaneous Electrical Nerve Stimulation (DTENS) + PFMT based on Kegel's exercises

B (n=36): PFMT based on Kegel's exercises (control group)

Length of follow-up: not reported

Number of dropouts not reported


OutcomesContinence described according to Catalona's definition and measured with

- subjective visual analogue scale of improvement

- mean number of pads used daily

- 24-hour pad test: maximal speed of recovery from incontinence, grams/month

Data collected at 1, 4, and 6 months post-operatively

Number of men dry at 4 months: A 82%, B 65% (wet: A 6/34, B 13/36)

Number of men dry at 6 months: A 87%, B 76% (wet: A 4/34, B 9/36)

Number of pads (mean per day): A 1, B 1.5 (no SDs given)


NotesOnly abstract available.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskReported as "randomized trial" but method of sequence generation not specified

Allocation concealment (selection bias)Unclear riskReported as "randomized trial" but method of allocation concealment not specified

Blinding (performance bias and detection bias)
All outcomes
Unclear riskNot specified

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskNot specified

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot specified

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNo information or reporting about attrition and exclusions (we assumed there were no dropouts)

Selective reporting (reporting bias)Unclear riskAssessment is based upon the published abstract. Complete report of the trial and the protocol not available.

Other biasUnclear riskInformation not provided about the method of statistical analysis; lost to follow-up (if any); dropouts (if any), and whether or not intention-to-treat analysis (ITT) performed.

Hoffmann 2005

Methods3-arm Randomized Controlled Trial


ParticipantsParticipants underwent radical retropubic prostatectomy with post-operative grade 3 SUI
Mean age: 65.0 years

Inclusion: between 12 and 35 days post-surgery


InterventionsA (n=60): Transcutaneous (perineal) ES (20 minutes, max amp 70 mA, pulse width 250 ms, frequency 14 Hz, biphasic) + PMFT
B (n=60): Transcutaneous (anal) ES (same parameters as perineal ES) + PMFT
C (n=60): PMFT thrice a week, group training 30 minutes (control group)

Length of follow-up: 3 months after discharge


OutcomesIncontinence defined as "self reports of incontinence" and measured with:

  • 1-hour ICS pad test
  • VAS-incontinence
  • Uroflowmetry


Quality of life measured with EORTC QLQ C30

Number of men with incontinence at end of treatment: A 54/56, B 37/38, C 54/55

Adverse effects leading to dropout: A 2/60 (discomfort) + 2/60 (pain); B 16/60 (discomfort) + 4/60 (pain); C 0/60

Deterioration in SUI: A 1/60, B 2/60, C 0/60


NotesAuthors state that additional use of ES was only significantly superior to PFMT alone in a highly compliant subgroup. Dropouts: 22 out of 60 in anal ES group, 4 out of 60 in perineal ES group. No reasons for dropouts given. High score on device errors and lack of patient compliance.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer-generated randomization

Allocation concealment (selection bias)Unclear riskMethod of allocation concealment not specified

Blinding (performance bias and detection bias)
All outcomes
Unclear riskInsufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskInsufficient information to permit judgement

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInsufficient information to permit judgement

Incomplete outcome data (attrition bias)
All outcomes
High riskDropouts: 22 out of 60 in anal ES group, 4 out of 60 in perineal ES group. No reasons for dropouts given.

Selective reporting (reporting bias)Unclear riskProtocol not available

Other biasHigh riskNo intention-to-treat analysis; insufficient information on methods of statistical analysis; interventions unclear and insufficiently specified.

Moore 1999

Methods3-arm Randomized Controlled Trial


ParticipantsParticpants were post-radical prostatectomy patients with incontinence based on 24-hour pad test and questionnaires (Incontinence Impact Questionnaire IIQ7 and EORTC QLQ C30)
Age: mean 67 years (range 49 to 77 years)


InterventionsA (n=21): PFMT in outpatient clinic 2 per week for 12 weeks + home exercises
B (n=21): PFMT in outpatient clinic 2 per week for 12 weeks + ES via surface anal electrode + home exercise

C (n=21): pre and post-operative oral and written information about PFMT

Home exercises: 12-20 contractions of 5-10 seconds, 8-10 contractions of 20-30 seconds and repetitive contractions in 10 seconds 3 per day

Length of follow up was 24 weeks


OutcomesReported following outcomes:

  • Continence defined as less than or equal to 2 gm urine per 24 hours
  • Urine loss (measured by 24-hour pad test)
  • Quality of life:
    • Incontinence Impact Questionnaire
    • European Organization for the Research and Treatment of Cancer-EORTC QLQ C-30
    • Physical symptom inventor


Data collection: baseline and at 12 weeks, 16 weeks and 24 weeks

Number of incontinent men at 3 months: A 12/18, B 11/19, C 14/21

Number of incontinent men at 6 months: A 8/18, C 7/21 (B not given)

24 hour pad test (grams urine lost, mean (SD) n):

  • At 3 months: A 87 (123) 18, B 156 (168) 19, C 104 (176) 21
  • At 6 months: A 74 (131) 18, B 202 (242) 19, C 67 (137) 21
  • At 12 months: A 70 (114) 17, B 98 (132) 19, C 54 (103) 21


Adverse effects: A 2/18 (anal pain), B 0/19, C 0/21


NotesPower calculation performed.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Participants were assigned using a computer-generated random-number list placed in sealed envelopes at the end of the assessment visit, with patient and researcher opening the sealed envelope"

Allocation concealment (selection bias)Low risk"participants were assigned using a computer-generated random-number list placed in sealed envelopes at the end of the assessment visit, with patient and researcher opening the sealed envelope"

Blinding (performance bias and detection bias)
All outcomes
Unclear riskBlinding to intervention not possible, however outcome assessor was blinded

Blinding of participants and personnel (performance bias)
All outcomes
Low riskPhysiotherapists were blinded

Blinding of outcome assessment (detection bias)
All outcomes
Low riskOutcome assessors were blinded

Incomplete outcome data (attrition bias)
All outcomes
Unclear risk"Five dropouts, three with bladder neck contractures requiring dilatation, one with rectal pain when doing the exercise and one unable to complete therapy while on vacation." However, there was no differential dropout from one group.

Selective reporting (reporting bias)Unclear riskProtocol not available

Other biasUnclear riskIntention-to-treat-analysis not performed.

Wille 2003

Methods3-arm Randomized Controlled Trial


ParticipantsParticipants undergoing radical prostatectomy with post-operative urinary incontinence
Age: mean 64.6 (in group A and B) and 65.9 (group C)


InterventionsA (n=47): PFMT

B (n=46): PFMT + ES via surface anal electrode with a bio-impulser for 15 minutes

C (n=46): PFMT + ES + biofeedback 15 minutes sessions two times per day for 3 months

All groups received instructions about PFMT by physiotherapist

They were instructed to perform PFMT for 20 to 30 minutes, two times per day for 3 months plus 3 weeks of rehabilitation programme after discharge. There was regular interaction with the healthcare professional and the patient during the first 6 weeks after surgery.

Length of follow up was 12 months


OutcomesThe following outcomes were reported at baseline, 3 months and 12 months post-operatively:

  • Urine loss measure by questionnaire (subjective) and 20 minutes provocative mean pad test (objective)
  • Quality of life EORCT QLQ-C30: scores for physical; role; emotional; social; and global quality of life were not significantly different between the groups at 3 or 12 months (no SDs provided)


Continence defined as reported use of 0 to1 pads by questionnaire (subjective outcome)

Wet at 3 months: A 19/47, B 16/46, C 22/46

Wet at 12 months: A 6/47, B 9/46, C 5/46

Number of participants with loss of <1 gram of urine on pad test (objective outcome)

Wet at 12 months: A 9/47, B 8/46, C 4/46

Willingness to undergo surgery again (satisfaction): A 73%, B 83%, C 73%


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskReported as "prospective randomized trial" but method of sequence generation not specified

Allocation concealment (selection bias)Unclear riskReported as "prospective randomized trial" but method of sequence generation not specified

Blinding (performance bias and detection bias)
All outcomes
Unclear riskNot specified

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskNot specified

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot specified

Incomplete outcome data (attrition bias)
All outcomes
Unclear risk"Resuts at baseline after catheter removal, at 3 and 12 months postoperatively were available for 139, 120 and 128 (questionnaires at three different time points) and 116, 79 and 124 (pad test at three different time points) patients, respectively". However, no information about individual groups.

Selective reporting (reporting bias)Unclear riskProtocol not available

Other biasUnclear riskReasons for dropouts not provided.

Yamanishi 2010

Methods2-arm Randomized Controlled Trial


ParticipantsMen with severe urinary incontinence (> 200 gram daily) after radical prostatectomy
Mean age: mean (SD) 66.2 (6.2) Range [50 to 76]

Inclusion criteria: UI > 200 gram daily after removal of catheter, no residual cancer after radical prostatectomy on pathological examination

Exclusion criteria: Participants on anticholinergics or tricyclic antidepressants, neurological disorders and urethral strictures


InterventionsParticipants were taught by nurses about PFMT before the surgery and continued at the follow-up visits

A (n=26) intervention: PFMT plus anal electrical stimulation for 15 minutes twice daily (50 Hz square waves with 300 μsec pulse duration, maximum output 70mA (5 seconds on, 5 seconds off-duty cycle)

B (n=30) control: PFMT plus sham stimulation (output 3mA, 2 seconds on, 13 seconds off-duty cycle)

Length of follow up: 1 months, 3 months , 6 months and 12 months after treatment


OutcomesNumber of incontinent men

24 hour pad test weights

ICIQ-SF score

ICIQ-QoL score

Time until continent in months

Adverse effects


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"Randomisation was done by computer"

Allocation concealment (selection bias)Low risk"None of the patients, doctors or medical staff knew which type of stimulation had been assigned until the key code was opened"

Blinding (performance bias and detection bias)
All outcomes
Low riskSeems to be adequate, but no report when key-code was broken

Blinding of participants and personnel (performance bias)
All outcomes
Low riskBlinding of doctors, nurses and medical staff

Blinding of outcome assessment (detection bias)
All outcomes
Low riskBlinding of assessors, medical staff

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskIt is reported that "In the active ES group 2 patients discontinued after 2 and 3 months, respectively, due to urethral stricture at the bladder neck. In the sham group 1 patient discontinued treatment at 7 months because of an increase in prostate specific antigen and he then underwent radiation therapy." However, there is no evidence that dropout was related to trial interventions.

Selective reporting (reporting bias)Unclear riskProtocol not available

Other biasHigh riskNumber of dropouts given, but reasons not specified.

Yokoyama 2004

Methods3-arm Randomized Controlled Trial


ParticipantsRecruitment: Post-operative

Included: 36 men with urinary incontinence after retropubic radical prostatectomy with incontinence defined as >100 gram on 24-hour pad test, one day after catheter removal

Mean age (SD): Group A 67.2 (6.7) years, Group B 68.2 (4.9) years, Group C 66.2 (7.6) years


InterventionsA (n=12) intervention: anal electrode for 15 minutes twice a day for 1 month

B (n=12) intervention: extracorporeal magnetic innervation, neocontrol system, treatment sessions 20 minutes, twice a week for 2 weeks

C (n=12) control: PFMT, digital anal teaching of correct contractions, then verbal and written instructions for home practice

Length of follow up: 6 months


Outcomes24-hour pad test weight (grams):

3 months: A 34 gram, B 7.3 gram, C 50 gram

6 months: For all groups less than 10 gram

Quality of Life measured by I-QOL: Improvement in all groups over time, no statistically significant difference between the groups

Remaining UI at 6 months: A 2/12, B 1/12, C 2/12


NotesDropouts: It appears that there are no drop outs but this was not specifically mentioned.

Side effects: No complaints about discomfort or irritation from the probe.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear risk".........randomly assigned to three groups....." no further details about sequence generation provided

Allocation concealment (selection bias)Unclear risk".........randomly assigned to three groups....." no further details about allocation concealment provided

Blinding (performance bias and detection bias)
All outcomes
Unclear riskNot specified

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskNot specified

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot specified

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo missing data

Selective reporting (reporting bias)Unclear riskProtocol not available

Other biasLow riskIt appears that there are no dropouts but this was not specifically mentioned. Study appears to be free of other sources of bias.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Bocker 2002Men (post-prostatectomy) and women (with post-polio syndrome) included, no separate reporting of results

Goode 2009No analysis of separate results of ES possible, because ES always combined with biofeedback

Hasan 1994Both men and women included, without separate reporting of results

Lin 2004Both full-text report and abstract only available in the Chinese language

Mariotti 2009No analysis of separate results of ES possible, because ES always combined with biofeedback

McClurg 2008Both men and women included, without separate reporting of results

Petersen 1994Not an RCT, consecutive patients. Neurogenic urinary incontinence due to neurogenic detrusor overactivity in both men and women without separate reporting

Soomro 2001Both men and women included, without separate reporting of results

Walsh 2001Both men and women included, without separate reporting of results

Webb 1992Both men and women included, without separate reporting of results

Yamanishi 1997aBoth men and women included, without separate reporting of results

Yamanishi 1998aBoth men and women included, without separate reporting of results

Yamanishi 2000aBoth men and women included, without separate reporting of results

Yasuda 1994Both men and women included, without separate reporting of results

 
Comparison 1. ES with non-implanted devices versus no active treatment

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Number of men with urinary incontinence1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    1.1 3 months: Anal ES + PFMT vs standard treatment
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   1.2 6 months: Anal ES + PFMT vs standard treatment
0Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   1.3 12 months: Anal ES + PFMT vs standard treatment
0Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 24-hr pad test (grams of urine lost)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    2.1 <3 months: Anal ES + PFMT vs standard treatment
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.2 3 months: Anal ES + PFMT vs standard treatment
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.3 6 months: Anal ES + PFMT vs standard treatment
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 2. ES with non-implanted devices versus placebo

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Number of men with urinary incontinence1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    1.1 Urinary incontinence at 3 months
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.2 Urinary incontinence at 6 months
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.3 Urinary incontinence at 12 months
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 24-hr Pad test (grams loss of urine)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    2.1 Urine loss at 3 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.2 Urine loss at 6 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.3 Urine loss at 12 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 3 Urinary incontinence score (Short Form International Consultation of Incontinence Score1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    3.1 Score at 3 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.2 Score at 6 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.3 Score at 12 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Quality of life score: International Consultation of Incontinence Questionnaire1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    4.1 Score at 3 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    4.2 Score at 6 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    4.3 Score at 12 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 5 Adverse events1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    5.1 During treatment
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 4. ES with non-implanted devices combined with other therapy versus other therapy without ES

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Number of men with urinary incontinence (subjective): at 3 months4Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    1.1 Transcutaneous (Anal) ES + PFMT vs PFMT alone
3269Risk Ratio (M-H, Fixed, 95% CI)0.98 [0.84, 1.15]

    1.2 Transcutaneous (Perineal) ES + PFMT vs PFMT
1111Risk Ratio (M-H, Fixed, 95% CI)0.98 [0.92, 1.04]

    1.3 ES (not specified) + PFMT vs PFMT
170Risk Ratio (M-H, Fixed, 95% CI)0.49 [0.21, 1.14]

    1.4 Transcutaneous ES (any) + PFMT vs PFMT alone
4395Risk Ratio (M-H, Fixed, 95% CI)0.93 [0.82, 1.06]

 2 Number of men with urinary incontinence (subjective): at 6 months1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    2.1 Transcutaneous ES + PFMT vs PFMT
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 3 Number of men with urinary incontinence (subjective): at 12 months1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    3.1 Anal ES + PFMT vs PFMT
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Quality of life (EORTC QLQ 30)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    4.1 Transcutaneous (Anal) ES + PFMT vs PFMT
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    4.2 Transcutaneous (Perineal) ES + PFMT vs PFMT
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 5 Number of men with urinary incontinence (objective): anal ES1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    5.1 Anal ES + PFMT vs PFMT alone
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 6 Mean number of pads/day (from voiding diary)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    6.1 Transcutaneous ES + PFMT vs PFMT
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 7 24-hr pad test (grams of urine lost)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    7.1 <3 months: Anal ES + PFMT vs PFMT alone
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    7.2 3 months: Anal ES + PFMT vs PFMT alone
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    7.3 6 months: Anal ES + PFMT vs PFMT alone
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 8 Adverse effects2Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    8.1 Transcutaneous (Anal) ES + PFMT vs PFMT alone
2178Risk Ratio (M-H, Fixed, 95% CI)9.77 [2.42, 39.44]

    8.2 Transcutaneous (Perineal) ES + PFMT vs PFMT
1120Risk Ratio (M-H, Fixed, 95% CI)7.0 [0.37, 132.66]

    8.3 Transcutaneous (any) ES + PFMT vs PFMT alone
2238Risk Ratio (M-H, Fixed, 95% CI)7.04 [1.51, 32.94]

 
Comparison 5. One type of ES with non-implanted devices versus other ES

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Patient perceived recovery (dichotomous scales)1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    1.1 Stress urinary incontinence
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   1.2 Urgency urinary incontinence
0Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   1.3 Mixed urinary incontinence
0Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

   1.4 Urinary incontinence: stress, urgency or mixed UI
0Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 1-hr PAD test (grams loss of urine)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    2.1 Stress urinary incontinence
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   2.2 Urgency urinary incontinence
0Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   2.3 Mixed urinary incontinence
0Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

   2.4 Urinary incontinence: stress, urgency or mixed UI
0Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 3 Quality of life (EORTC QLQ 30)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    3.1 Stress urinary incontinence
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]