Portal de Periódicos da CAPES

Weighted vaginal cones for urinary incontinence

2002; Cochrane; Linguagem: Inglês

10.1002/14651858.cd002114

1469-493X

Peter Herbison, Nicola Dean,

Hernia repair and management

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.