Conservative management for postprostatectomy urinary incontinence
Notice bibliographique
Résumé
BACKGROUND: Urinary incontinence is common after both radical prostatectomy (RP) and transurethral resection of the prostate (TURP). Conservative management includes pelvic floor muscle training (PFMT) with or without biofeedback, electrical stimulation, compression devices (penile clamps), lifestyle changes, extra-corporeal magnetic innervation or a combination of methods. OBJECTIVES: To assess the effects of conservative management for urinary incontinence after prostatectomy. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 23 January 2006), MEDLINE (January 1966 to January 2006), EMBASE (January 1988 to January 2006), CINAHL (January 1982 to January 2006), PsycLIT (January 1984 to January 2006), ERIC (January 1984 to January 2006), the reference lists of relevant articles, handsearched conference proceedings and contacted investigators to locate studies. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials evaluating conservative interventions for urinary continence after prostatectomy. DATA COLLECTION AND ANALYSIS: At least two review authors assessed the methodological quality of trials and abstracted data. MAIN RESULTS: Seventeen trials met the inclusion criteria, fifteen trials amongst men after radical prostatectomy (RP), one trial after transurethral resection of the prostate (TURP) and one trial after either operation. There was considerable variation in the interventions, populations and outcome measures. The majority of trials in this area continue to be of moderate quality, although more recent studies have been of higher quality in terms of both randomization and blinding. Data were not available in all the trials for many of the pre-stated outcomes. Confidence intervals have tended to be wide except for the more recent studies, and it continues to be difficult to reliably identify or rule out a useful effect. There were several important variations in the populations being studied. Therefore the decision was made by the review authors to separate in the analysis the men having the intervention as prevention (whether administered before or after operation, to all men having surgery) or as treatment (postoperatively to those men who did have urinary incontinence), as well as separating those treated with TURP or RP. Amongst seven treatment trials of postoperative PFMT for urinary incontinence after RP, one trial suggested benefits, whereas the estimates from the others were consistent with no effect. There was clinical and statistical heterogeneity, precluding meta-analysis. There was no clear reason for this heterogeneity. Trials of preventative PFMT started pre or post-operatively also showed heterogeneity: only one large trial favoured PFMT but the data from the others were conflicting. Analysis of other conservative interventions such as transcutaneous electrical nerve stimulation and anal electrical stimulation, or combinations of these interventions were inconclusive. There were too few data to determine treatment effects on incontinence after TURP. The findings should continue to be treated with caution, as most studies were of poor to moderate quality. With respect to other management, men in one trial reported a preference for one type of external compression device compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remains undetermined as no trials involving these interventions were identified. Men's symptoms tended to improve over time, irrespective of management. AUTHORS' CONCLUSIONS: The value of the various approaches to conservative management of postprostatectomy incontinence remains uncertain. Long-term incontinence may be managed by external penile clamp, but there are safety problems.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,020 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,019 | 0,003 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».