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Meta-Analysis
. 2014 Dec 17;2014(12):CD001756.
doi: 10.1002/14651858.CD001756.pub6.

Mechanical devices for urinary incontinence in women

Allyson Lipp  1 , Christine Shaw, Karin Glavind
Affiliations
Meta-Analysis

Mechanical devices for urinary incontinence in women

Allyson Lipp et al. Cochrane Database Syst Rev. .

Abstract

Background: Incontinence can have a devastating effect on the lives of sufferers with significant economic implications. Non-surgical treatments such as pelvic floor muscle training and the use of mechanical devices are usually the first line of management, particularly when a woman does not want surgery or when she is considered unfit for surgery. Mechanical devices are inexpensive and do not compromise future surgical treatment.

Objectives: To determine whether mechanical devices are useful in the management of adult female urinary incontinence.

Search methods: For this second update we searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 21 August 2014), EMBASE (January 1947 to 2014 Week 34), CINAHL (January 1982 to 25 August 2014), and the reference lists of relevant articles.

Selection criteria: All randomised or quasi-randomised controlled trials of mechanical devices in the management of adult female urinary incontinence determined by symptom, sign or urodynamic diagnosis.

Data collection and analysis: The reviewers assessed the identified studies for eligibility and risk of bias and independently extracted data from the included studies. Data analysis was performed using RevMan software (version 5.3).

Main results: One new trial was identified and included in this update bringing the total to eight trials involving 787 women. Three small trials compared a mechanical device with no treatment and although they suggested that use of a mechanical device might be better than no treatment, the evidence for this was inconclusive. Four trials compared one mechanical device with another. Quantitative synthesis of data from these trials was not possible because different mechanical devices were compared in each trial using different outcome measures. Data from the individual trials showed no clear difference between devices, but with wide confidence intervals. One trial compared three groups: a mechanical device alone, behavioural therapy (pelvic floor muscle training) alone and behavioural therapy combined with a mechanical device. While at three months there were more withdrawals from the device-only group, at 12 months differences between the groups were not sustained on any measure.

Authors' conclusions: The place of mechanical devices in the management of urinary incontinence remains in question. Currently there is little evidence from controlled trials on which to judge whether their use is better than no treatment and large well-conducted trials are required for clarification. There was also insufficient evidence in favour of one device over another and little evidence to compare mechanical devices with other forms of treatment.

PubMed Disclaimer

Conflict of interest statement

Dr K. Glavind (one of the original authors of the review) is an author of an included trial.

Figures

1
1
PRISMA study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Intravaginal mechanical device versus no treatment, Outcome 1 Formal pad weighing tests after exercise(grams).
1.2
1.2. Analysis
Comparison 1 Intravaginal mechanical device versus no treatment, Outcome 2 Number with discomfort or pain.
1.3
1.3. Analysis
Comparison 1 Intravaginal mechanical device versus no treatment, Outcome 3 Variation of IEF per week from baseline.
1.4
1.4. Analysis
Comparison 1 Intravaginal mechanical device versus no treatment, Outcome 4 24 hour pad test change from baseline.
1.5
1.5. Analysis
Comparison 1 Intravaginal mechanical device versus no treatment, Outcome 5 Urinary Symptom Profile questionnaire SUI subscore.
1.6
1.6. Analysis
Comparison 1 Intravaginal mechanical device versus no treatment, Outcome 6 Urinary Symptom Profile questionnaire OAB subscore.
1.7
1.7. Analysis
Comparison 1 Intravaginal mechanical device versus no treatment, Outcome 7 Urinary Symptom Profile questionnaire dysuria subscore.
1.8
1.8. Analysis
Comparison 1 Intravaginal mechanical device versus no treatment, Outcome 8 CONTILIFE quality of life questionnaire.
2.1
2.1. Analysis
Comparison 2 Intravaginal Tampax tampon versus Hodge pessary, Outcome 1 Formal pad weighing tests.
2.2
2.2. Analysis
Comparison 2 Intravaginal Tampax tampon versus Hodge pessary, Outcome 2 Number with discomfort or pain.
3.1
3.1. Analysis
Comparison 3 Intravaginal Contrelle Continence Tampon (CCT) device versus intravaginal Conveen Continence Guard (CCG) device, Outcome 1 24h pad test.
5.1
5.1. Analysis
Comparison 5 Intraurethral new expandable tip (NEAT) device versus Reliance device, Outcome 1 Numbers improved (pad test).
6.1
6.1. Analysis
Comparison 6 Intraurethral Reliance device versus intraurethral FemAssist device, Outcome 1 Numbers subjectively dry (six months).
6.2
6.2. Analysis
Comparison 6 Intraurethral Reliance device versus intraurethral FemAssist device, Outcome 2 Numbers subjectively improved (six months).
6.3
6.3. Analysis
Comparison 6 Intraurethral Reliance device versus intraurethral FemAssist device, Outcome 3 Pad weighing test (six months).
6.4
6.4. Analysis
Comparison 6 Intraurethral Reliance device versus intraurethral FemAssist device, Outcome 4 Pad changes over 5 days.
6.5
6.5. Analysis
Comparison 6 Intraurethral Reliance device versus intraurethral FemAssist device, Outcome 5 Number of patients with UTI (six months).
6.6
6.6. Analysis
Comparison 6 Intraurethral Reliance device versus intraurethral FemAssist device, Outcome 6 Incontinence episodes per day (six months).
6.7
6.7. Analysis
Comparison 6 Intraurethral Reliance device versus intraurethral FemAssist device, Outcome 7 King's Health Questionnaire (six months).
6.8
6.8. Analysis
Comparison 6 Intraurethral Reliance device versus intraurethral FemAssist device, Outcome 8 SF‐36 (six months).
7.1
7.1. Analysis
Comparison 7 Intravaginal pessary versus behavioural therapy (PFMT), Outcome 1 Numbers improved 3 & 12 months.
7.2
7.2. Analysis
Comparison 7 Intravaginal pessary versus behavioural therapy (PFMT), Outcome 2 Satisfaction with treatment at 3 & 12 months.
7.3
7.3. Analysis
Comparison 7 Intravaginal pessary versus behavioural therapy (PFMT), Outcome 3 Withdrawal due to failure/lack of efficacy/dissatisfaction 3 & 12 mths.
7.4
7.4. Analysis
Comparison 7 Intravaginal pessary versus behavioural therapy (PFMT), Outcome 4 Improved UIQ 3 months.
7.5
7.5. Analysis
Comparison 7 Intravaginal pessary versus behavioural therapy (PFMT), Outcome 5 Improved on UDI 3 mths.
7.6
7.6. Analysis
Comparison 7 Intravaginal pessary versus behavioural therapy (PFMT), Outcome 6 Improved on QUID stress 3 mths.
7.7
7.7. Analysis
Comparison 7 Intravaginal pessary versus behavioural therapy (PFMT), Outcome 7 Improved on QUID urge 3 mths.
8.1
8.1. Analysis
Comparison 8 Intravaginal pessary alone versus pessary + PFMT, Outcome 1 Numbers improved 3 & 12 months.
8.2
8.2. Analysis
Comparison 8 Intravaginal pessary alone versus pessary + PFMT, Outcome 2 Satisfaction with treatment at 3 & 12 months.
8.3
8.3. Analysis
Comparison 8 Intravaginal pessary alone versus pessary + PFMT, Outcome 3 Withdrawal due to failure/lack of efficacy/dissatisfaction.
9.1
9.1. Analysis
Comparison 9 Pessary + PFMT versus behavioural therapy (PFMT) alone, Outcome 1 Numbers improved 3 & 12 months.
9.2
9.2. Analysis
Comparison 9 Pessary + PFMT versus behavioural therapy (PFMT) alone, Outcome 2 Satisfaction with treatment at 3 & 12 months.
9.3
9.3. Analysis
Comparison 9 Pessary + PFMT versus behavioural therapy (PFMT) alone, Outcome 3 Withdrawal due to failure/lack of efficacy/dissatisfaction 3 & 12 mths.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Fader 2001 {published data only}
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References to other published versions of this review

Frazer 1999
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