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Intervention Review

Weighted vaginal cones for urinary incontinence

  1. G Peter Herbison1,*,
  2. Nicola Dean2

Editorial Group: Cochrane Incontinence Group

Published Online: 21 JAN 2002

Assessed as up-to-date: 24 JUN 2007

DOI: 10.1002/14651858.CD002114


How to Cite

Herbison GP, Dean N. Weighted vaginal cones for urinary incontinence. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002114. DOI: 10.1002/14651858.CD002114.

Author Information

  1. 1

    Dunedin School of Medicine, University of Otago, Department of Preventive & Social Medicine, Dunedin, New Zealand

  2. 2

    York Hospitals NHS Foundation Trust, Obstetrics & Gynaecology, York, UK

*G Peter Herbison, Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, 9054, New Zealand. peter.herbison@otago.ac.nz.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2002

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This is not the most recent version of the article. View current version (08 JUL 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

For a long time pelvic floor muscle training (PFMT) has been the most common form of conservative treatment for stress urinary incontinence (SUI). Weighted vaginal cones can be used to help women to train their pelvic floor muscles. Cones are inserted into the vagina and the pelvic floor is contracted to prevent them from slipping out.

Objectives

To evaluate the effectiveness of weighted vaginal cones in the treatment of female SUI.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 25 June 2007), MEDLINE (January 1966 to June 2007), EMBASE (January 1988 to June 2007) and reference lists of relevant articles.

Selection criteria

Randomised or quasi-randomised controlled trials comparing weighted vaginal cones with alternative treatments or no treatment.

Data collection and analysis

Three reviewers independently assessed studies for inclusion and trial quality. Data was extracted by one reviewer and cross checked by the others. Study authors were contacted for extra information.

Main results

Seventeen studies, involving 1484 women of whom 646 received cones, were included. All of the trials were small, and in many the quality was hard to judge. Outcome measures differed between studies, making the results difficult to combine. Some studies reported high dropout rates with both cone and comparison treatments. Six trials were published only as abstracts.

Cones were better than no active treatment (RR for failure to cure incontinence 0.88, 95% CI 0.79 to 0.98). There was little evidence of difference between cones and PFMT (RR 1.00, 95% CI 0.91 to 1.11), or electrostimulation (RR 1.00, 95% CI 0.86 to 1.13), but the confidence intervals were wide. There was not enough evidence to show that cones plus PFMT was different to either cones alone or PFMT alone. Only three studies used a quality of life measure and no study looked at economic outcomes.

Four of the studies recruited women with symptoms of incontinence, while the others required women with urodynamic stress incontinence, and the inclusion criteria for one trial were uncertain.

Authors' conclusions

This review provides some evidence that weighted vaginal cones are better than no active treatment in women with SUI and may be of similar effectiveness to PFMT and electrostimulation. This conclusion must remain tentative until larger, high-quality studies, that use comparable and relevant outcomes, are completed. Cones could be offered as one treatment option, if women find them acceptable.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Vaginal weights for training the pelvic floor muscles to treat urinary incontinence in women

Leaking urine when coughing, sneezing, or exercising (stress urinary incontinence) is a common problem for women. This is especially so after giving birth, when about one woman in three will leak urine. Training of the pelvic floor muscles is the most common form of treatment for this problem. One way that women can train these muscles is by inserting cone-shaped weights into the vagina, and then contracting the pelvic floor muscles to stop the weights from slipping out again.

Seventeen small studies, involving 1484 women, were found. The results of these studies consistently showed that the use of vaginal weights is better than having no treatment. When vaginal weights were compared to other treatments, such as pelvic floor muscle training without the weights, and electrical stimulation of the pelvic floor, no clear differences between the treatments were evident. This may have been because the numbers of participants in the trials were small, and larger numbers may be required for any differences in the effectiveness of treatments to become clear.

Some women find vaginal weights unpleasant or difficult to use, so this treatment may not be useful for all women.

Many women with stress urinary incontinence will not be cured by these treatments, and so it is important for studies to assess quality of life during and after treatment, but few of these studies did. Most of the studies were fairly short term, so it is difficult to say what happens to women with stress urinary incontinence in the longer term.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

治療尿失禁之陰道錐體訓練法

骨盆底肌肉訓練是近來最常見用來治療應力性尿失禁的保守方法。陰道錐體訓練法協助婦女訓練其骨盆底肌肉。錐體置入陰道後,骨盆底肌肉會收縮來防止它滑出。

目標

評估陰道錐體訓練法治療女性應力性尿失禁之效能。

搜尋策略

我們搜尋了Cochrane Incontinence Group Specialised Trials Registe (2005年10月3日),MEDLINE(1966年1月至2005年12月),EMBASE(1988年1月至2005年12月)和相關文獻。我們聯絡研究人員以取得其他研究的細節。

選擇標準

比較使用陰道錐體訓練法與替代療法或未治療之應力性尿失禁女性病患的隨機或半隨機對照試驗。

資料收集與分析

三位審查者獨立評估了研究的內容和試驗品質。由一位審查者摘錄數據,再由另外兩位核對。與研究之作者聯繫取得進一步的資訊。

主要結論

共納入16個研究,包括1246位女性,其中有566人接受置入錐體。 所有的試驗樣本數都不多,大部份的品質也難以評估。眾研究的測量結果的方法不一,很難將結果加以整合。部分研究的陰道錐體訓練法或替代療法之退出率均偏高。有六個研究僅發表摘要。陰道錐體訓練法比不治療有效(治療尿失禁失敗之相對風險為0.74,95%信賴區間為0.59 – 0.93)。少許證據顯示陰道錐體訓練法及PFMT之間有差異(相對風險為1.09,95%信賴區間為0.86 – 1.38),陰道錐體訓練法及電刺激也沒有明顯差異(相對風險為1,95%信賴區間為0.89 – 1.13),但相賴區間的範圍較大。沒有證據顯示陰道錐體訓練法合併PFMT治療,與單獨使用陰道錐體訓練法或PFMT間的效果有差異。只有三篇研究使用生活品質量表,且沒有研究著重於經濟效益的考量。四篇研究納入有尿失禁症狀的女性,其他則是界定為須有尿動力學證明的壓力型尿失禁,有一篇收案條件則無法確定。研究的測量結果的方法不一,很難將結果加以整合。部分研究報告指出接受陰道錐體訓練法相關治療方法的個案有較高的退出率,整體而言與接受其他治療方法個案的退出率沒有差異。陰道錐體訓練法的效果較控制組之治療方法佳,但無證據顯示其療效與PFMT及電刺激療法有差異,亦沒有證據顯示陰道錐體訓練法合併PFMT治療,與單獨使用陰道錐體訓練法或PFMT間的效果有差異。所有的結論納入主觀和客觀的結果,只有三篇研究使用生活品質量表,且沒有研究著重於經濟效益的考量。

作者結論

審查結果提供了一些證據,顯示相較於不主動積極治療的尿失禁女性,使用陰道錐體訓練法治療的成效較佳,且可能與PFMT及電刺激療法有相類似的效益。在未來使用可比較且相關的結果量測方式進行更進一步大型、高品質研究之前,這些結論將暫時繼續存在。一些接受陰道錐體訓練法、骨盆底肌肉訓練或電刺激治療方法的女性會在早期即退出治療,因此,陰道錐體訓練法應提供作為其中一項選撰,如果女性覺得無法接受時,她們會知道仍有其他的治療方法。

翻譯人

本摘要由中國醫藥大學附設醫院蕭子玄翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

陰道錐體訓練法是用來訓練骨盆底肌肉,以治療女性尿失禁症狀。當女性咳嗽、打噴嚏或運動(應力性尿失禁)時漏尿是一個常見的問題,尤其有三分之一生產過的女性將有這樣的問題。骨盆底肌肉訓練是治療這類問題最常見的方式,其中之一是將錐體置入陰道,骨盆底肌肉會收縮以防止錐體滑出。共搜尋到16篇小型研究,包括1246位女性,均一致顯示陰道錐體訓練法比不接受治療有較好的結果。與其他治療方法比較時,例如非錐體置入的骨盆底肌肉訓練及骨盆底肌肉之電刺激,有少數的證據顯示其差異,但樣本數太少,很難確認其結果。許多女性對於陰道錐體感到不舒適或很難去使用,故這項治療方式可能不適用於所有女性。這些治療方式無法讓許多患有應力性尿失禁的女性痊癒,因此使用生活品質量表評估這些治療的結果是很重要的,但只有少數研究有這樣做。大部分的研究期間都很短,所以很難評估長期患有應力性尿失禁女性的情形。