Effect of Pelvic Floor Muscle Training Combined with Electrical Stimulation Therapy on Stress Urinary Incontinence: A Meta-Analysis.

Abstract

Introduction: SUI is a common pelvic floor dysfunction in middle-aged and elderly women, which has a serious negative impact on the patient's quality of life (QoL); pelvic floor muscle training (PFMT) and electrical stimulation (ES), as common non-surgical treatment modalities, have been widely used in the management of SUI. However, there is controversy about the effectiveness of the combined application of these two interventions. For this reason, this study evaluated the efficacy of PFMT combined with ES in the treatment of SUI by meta-analysis. To systematically evaluate the efficacy of PFMT combined with ES in improving urinary incontinence symptoms, increasing pelvic floor muscle strength, enhancing QoL, and improving clinical symptoms, with the aim of providing more adequate evidence to support clinical treatment.

Methods: A literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases from database construction to October 2024 to include RCTs and case-control studies evaluating PFMT combined with ES for the treatment of SUI. The Cochrane Risk Assessment Tool and NOS were used to assess the quality of the included literature, and effect sizes were calculated by random-effects model and fixed-effects model, and the main outcome indicators included incontinence symptoms, pelvic floor muscle strength, QoL, and clinical symptoms.

Results: Eight studies were ultimately included, with a total sample size of 885 cases. Meta-analysis showed that PFMT combined with ES was significantly better than the control group on all outcome measures. The combined effect size for improvement in urinary incontinence symptoms was OR = 1.42 (95% CI: 1.10, 1.85, p < 0.05), the combined effect size for pelvic floor muscle strength was OR = 1.55 (95% CI: 1.20, 2.05, p < 0.01), the combined effect size for QoL improvement was OR = 4.29 (95% CI: 3.68, 4.99, p < 0.0001), and the combined effect size for clinical symptom improvement was OR = 1.35 (95% CI: 1.05, 1.70, p < 0.05). Heterogeneity between studies was low (I2 values were less than 40%), indicating a high degree of consistency in the effect of the combination treatment.

Conclusion: PFMT combined with ES showed significant benefits in improving incontinence symptoms, enhancing pelvic floor muscle strength, boosting QoL, and improving clinical symptoms. Future studies should further standardize the intervention parameters and extend the follow-up period to fully assess the long-term effects of the combined treatment.