Efficacy of extracorporeal shock wave therapy for female stress urinary incontinence: a systematic review and meta-analysis.

Abstract

Background: Stress urinary incontinence (SUI) significantly impacts women's quality of life. Extracorporeal shock wave therapy (ESWT) has emerged as a promising non-invasive treatment option. This systematic review and meta-analysis evaluates the efficacy of ESWT in treating female SUI.

Methods: A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wanfang databases from their inception to January 2024 using 'extracorporeal shock wave', 'Low Intensity Extracorporeal Shock Wave Therapy' and 'stress urinary incontinence'. Randomised controlled trials (RCTs) and clinical studies comparing ESWT with control groups for SUI treatment were included. The primary outcomes included International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores and treatment efficacy. Secondary outcomes included Incontinence Impact Questionnaire-7 (IIQ-7), Overactive Bladder Symptom Score (OABSS) and Urogenital Distress Inventory (UDI) scores.

Results: Four studies involving 287 patients met the inclusion criteria. The ESWT method significantly improved ICIQ-SF scores [standardised mean difference (SMD) =-4.22, 95% confidence interval (CI): -6.71 to -1.73, I²=96.6%] equating to approximately 3.8 raw score points, exceeding the established minimal clinically important difference of 2.5 points and thus representing a clinically meaningful improvement. The method also demonstrated better treatment efficacy (risk ratio =0.30, 95% CI: 0.11-0.77, I²=0%). Significant improvements were also observed in OABSS (SMD =-1.88, 95% CI: -3.51 to -0.38, I²=91.2%). However, changes in IIQ-7 and UDI scores showed no statistical significance.

Conclusions: This meta-analysis suggests that ESWT is an effective treatment for SUI, significantly improving symptoms and quality-of-life measures. The evidence suggests that ESWT is a promising non-invasive option for SUI, particularly for patients seeking non-invasive alternatives to surgery. However, high heterogeneity among studies indicates the need for larger, well-designed RCTs to further validate these findings.