Conservative management for urinary incontinence in neurological patients: A systematic review and meta-analysis

Abstract

Aim: To summarize evidence from a search and review of the 7th International Consultation on Incontinence chapter’s section on conservative treatments in neurological patients. Methods:: Searching the Cochrane Incontinence Specialised Register (MEDLINE, CENTRAL, others) on August 2nd, 2022. Quality and certainty evidence were assessed using the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development and Evaluation. Results:: After screening 5416 records, 40 trials with 2751 participants were included and stratified according to the site and nature of the neurological disease: (1) Brain disorders n = 22; (2) Spinal cord disorders n = 3; (3) Multiple sclerosis (MS) n = 13; (4) Mixed types of neurological diseases n = 2. Pooled analysis from trials in participants with brain disorders showed that, compared to no active treatment, electrical stimulation (EStim) improved UI episodes per day based on very low certainty evidence and improved UI symptom measures based on moderate certainty evidence. Further, compared to usual care, toilet assistance improved neurological quality of life (QoL) measures based on moderate certainty evidence. Pooled analysis from trials in participants with MS showed that, compared to pelvic floor muscle training (PFMT) alone, PFMT plus EStim was effective for improving the number of UI episodes per day based on moderate certainty evidence. Conclusion:: Our review shows that neurological patients could benefit from conservative interventions to improve symptoms of UI, and QoL. Further well-designed trials with larger cohorts and longer-term follow-up are needed given the limited studies in this population.

Keywords

• Conservative interventions
• Lower urinary tract symptoms
• Nervous system disease
• Urinary incontinence