Treatment of urinary incontinence after stroke in adults

 

Abstract

Background

Urinary incontinence can affect 40-60% of people admitted to hospital after a stroke, with 25% still having problems on hospital discharge and 15% remaining incontinent at one year.

Objectives

To determine the optimal methods for treatment of urinary incontinence after stroke in adults.

Search methods

We searched the Cochrane Incontinence and Stroke Groups specialised registers (searched 15 March 2007 and 5 March 2007 respectively), CINAHL (January 1982 to January 2007), national and international trial databases for unpublished data, and the reference lists of relevant articles.

Selection criteria

Randomised or quasi-randomised controlled trials evaluating the effects of interventions designed to promote continence in people after stroke.

Data collection and analysis

Data extraction and quality assessment were undertaken by two reviewers working independently. Disagreements were resolved by a third reviewer.

Main results

Twelve trials with a total of 724 participants were included in the review. Participants were from a mixture of settings, age groups and phases of stroke recovery.

Behavioural interventions
Three trials assessed behavioural interventions, such as timed voiding and pelvic floor muscle training. All had small sample sizes and confidence intervals were wide.

Specialised professional input interventions
Two trials assessed variants of professional input interventions. Results tended to favour the intervention groups: in a small trial in early rehabilitation, fewer people had incontinence at discharge from hospital after structured assessment and management than in a control group (1/21 vs. 10/13; RR 0.06, 95% CI 0.01 to 0.43); in the second trial, assessment and management by Continence Nurse Advisors was associated with fewer participants having urinary symptoms (48/89 vs. 38/54; RR 0.77, 95% CI 0.59 to 0.99) and statistically significantly more being satisfied with care.

Complementary therapy interventions
Three small trials all reported fewer participants with incontinence after acupuncture therapy (overall RR 0.44; 95% 0.23 to 0.86), but there were particular concerns about study quality.

Pharmacotherapy and hormonal interventions
There were three small trials that included groups allocated meclofenoxate, oxybutinin or oestrogen. There were no apparent differences other than in the trial of meclofenoxate where fewer participants had urinary symptoms in the active group than in the control group (9/40 vs. 27/40; RR 0.33, 95% CI 0.18 to 0.62).

Authors' conclusions

Data from the available trials are insufficient to guide continence care of adults after stroke. However, there was suggestive evidence that professional input through structured assessment and management of care and specialist continence nursing may reduce urinary incontinence and related symptoms after stroke. Better quality evidence is required of the range of interventions that have been suggested for continence care after stroke.

 

Plain language summary

Treatment of urinary incontinence after stroke in adults

Urinary incontinence is a common consequence of stroke and has many causes. In early stroke rehabilitation, structured assessment and management of care shows promise in reducing the number of people with urinary incontinence. In the later phases of stroke recovery the use of specialist advisors may be helpful in reducing symptoms associated with urinary incontinence. Even late after stroke, interventions targeted at specific causes of incontinence may be helpful. Unfortunately, all the conclusions were limited by a lack of robust information.

 

摘要

背景

成人中風之後尿失禁之治療

40% – 60%因中風住院的病患受尿失禁所困擾, 25%的病患出院時還是依然面臨相同的窘境; 15%的病患甚至在出院一年後還是有尿失禁。

目標

針對中風之後尿失禁族群, 決定何種為最佳之治療方式。

搜尋策略

我們蒐尋了COCHRANE尿失禁和中風族群的專屬登記處(蒐集日期分別為2007.3.15和2007.3.5), CINAHL(1982.1至2007.1), 未發表在national and international trial databases的資料庫 和相關文章的參考文獻。

選擇標準

隨機或類隨機對照試驗: 評估一些介入的治療對中風後尿失禁病患所獲得的療效。

資料收集與分析

由兩位審稿者來進行資料擷取以及評估品質,若有意見不一的情形則請第三位審稿者來解決。

主要結論

一共納入十二組試驗的724位參與者。參與者來自不同的背景, 年齡層和中風痊癒時程。 行為性治療(Behavioural interventions): 有三組試驗針對行為性治療做評估, 例如排尿的時間和骨盆腔肌肉的訓練。這三組試驗都有樣本數少, 信賴區間寬的問題。 專科介入性治療(Specialised professional input intervention): 有兩組試驗針對專科介入性治療做評估。試驗結果為專科介入性治療為有效的治療方式: 在一個早期復建的小型試驗中, 病患經過結構性評估和治療之後, 較少病患出院時有尿失禁的狀況(1/21 vs. 10/13; RR 0.06, 95% CI 0.01 to 0.43); 在第二個試驗裡, 經過尿失禁專業護理人員(Continence Nurse Advisors)的評估和治療後, 較少病患有尿失禁的問題(48/89 vs. 38/54; RR 0.77, 95% CI 0.59 to 0.99), 如果經過尿失禁專業護理人員的照顧, 統計學上顯示治療結果更令人滿意。 輔助治療(Complementary therapy interventions): 三個小型試驗的報告指出少數的病患在接受針灸之後, 症狀獲得改善, 但是這三組試驗的品質是需要受到質疑的。 藥物治療(Pharmacotherapy and hormonal interventions): 共有三個小型試驗分別對meclofenoxate, oxybutinin或oestrogen的療效進行測試。除了meclofenoxate 之外, 其他兩種藥物的療效再跟對照組比較後,在統計學上都沒有顯著意義。(9/40 vs. 27/40; RR 0.33, 95% CI 0.18 to 0.62)。

作者結論

對於中風後病患所面臨的尿失禁問題, 現有的資料還不足以指出哪種治療方法是最適當的。但是有證據指出, 專科介入性治療和尿失禁專業護理人員(Continence Nurse Advisors)的評估與治療, 可以緩和中風後尿失禁的相關症狀。因此, 我們需要更有力的證據來證實對於中風後的尿失禁病患, 何為最適當的治療方式。

翻譯人

本摘要由中國醫藥大學附設醫院鍾文耀翻譯。

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

總結

專業人員的評估與治療似乎是對中風後病患尿失禁問題最令人激賞的治療方式。尿失禁是中風後常有的症狀, 有許多肇因匯引起這樣的症狀。中風的早期復健過程中, 結構性評估和治療能夠減少受尿失禁問題困擾的病患人數。在中風的中期恢復過程, 專業的建議也能起一定的作用。 甚至在後期, 我們也能夠對於因特殊肇因而引起的尿失禁進行治療。 不幸的是, 以上的結論都缺乏健全的證據作為理論基礎。