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CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(02): 116-123
DOI: 10.1055/s-0038-1676842
Review Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Occult Urinary Incontinence Treatment: Systematic Review and Meta-analysis—Brazilian Guidelines[*]

Tratamento de incontinência urinária oculta: revisão sistemática e metanálise – diretrizes brasileiras
Priscila Katsumi Matsuoka 
1   Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
,
Rodrigo Aquino Castro
2   Paulista Medical School, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Edmund Chada Baracat
1   Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
,
Jorge Milhem Haddad
1   Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

05 June 2018

05 November 2018

Publication Date:
20 February 2019 (online)

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Abstract

Objective To evaluate if performing anti-incontinence procedures during surgical anterior and/or apical prolapse correction in women with asymptomatic urinary incontinence (UI) may prevent stress urinary incontinence (SUI) postoperatively.

Methods We have performed a systematic review of articles published in the PubMed, Cochrane Library, and Lilacs databases until March 31, 2016. Two reviewers performed the data collection and analysis, independently. All of the selected studies were methodologically analyzed. The results are presented as relative risk (RR), with a 95% confidence interval (CI).

Results After performing the selection of the studies, only nine trials fulfilled the necessary prerequisites. In the present review, 1,146 patients were included. Altogether, the review included trials of three different types of anti-incontinence procedures. We found that performing any anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR = 0.50; 95% CI: 0.28–0.91). However, when we performed the analysis separately by the type of anti-incontinence procedure, we found different results. In the subgroup analysis with midurethral slings, it is beneficial to perform it to reduce the incidence of SUI (RR = 0.08; 95% CI: 0.02–0.28). On the other hand, in the subgroup analysis with Burch colposuspension, there was no significant difference with the control group (RR = 1.47; 95% CI: 0.28–7.79]).

Conclusion Performing any prophylactic anti-incontinence procedure at the same time as prolapse repair reduced the incidence of SUI postoperatively. The Burch colposuspension did not show any decrease in the incidence of SUI postoperatively.

Resumo

Objetivo: Avaliar se a realização de procedimentos anti-incontinência durante a correção cirúrgica do prolapso anterior e/ou apical em mulheres assintomáticas para incontinência urinária (IU) pode prevenir a incontinência urinária de esforço (IUE) no pós-operatório.

Métodos: Foi realizada uma revisão sistemática dos artigos publicados nas bases de dados PubMed, Cochrane Library e Lilacs até o dia 31 de março de 2016. Dois revisores realizaram a coleta e a análise de dados, de forma independente. Todos os estudos selecionados foram analisados metodologicamente. Os resultados estão apresentados como risco relativo (RR), com 95% de intervalo de confiança (IC).

Resultados: Após a seleção do estudo, apenas nove estudos preencheram os pré-requisitos necessários. Nesta revisão, 1.146 pacientes foram incluídos. No total, a revisão incluiu ensaios de três tipos diferentes de procedimentos anti-incontinência. Descobrimos que realizar qualquer procedimento anti-incontinência ao mesmo tempo que o reparo do prolapso reduziu a incidência de IU no pós-operatório (RR = 0,50; IC 95%: 0,28–0,91). No entanto, quando fizemos a análise separadamente pelo tipo de procedimento anti-incontinência, encontramos resultados diferentes. Na análise de subgrupos com slings miduretrais, é benéfico realizá-lo para reduzir a incidência de IU (RR = 0,08; IC 95%: 0,02–0,28). Por outro lado, na análise de subgrupo com colposuspensão de Burch, não houve diferença significativa com o grupo controle (RR = 1,47; IC 95%: 0,28–7,79]).

Conclusão: A realização de qualquer procedimento profilático anti-incontinência ao mesmo tempo que o reparo do prolapso reduziu a incidência de IUE no pós-operatório. A colposuspensão de Burch não mostrou diminuição na incidência de IUE no pós-operatório.

Keywords

occult urinary incontinence - systematic review - pelvic organ prolapse - meta-analysis - stress urinary incontinence

Palavras-chave

incontinência urinária oculta - revisão sistemática - prolapso de órgãos pélvicos - metanálise - incontinência urinária de esforço

* This is a Systematic Review and Meta-Analysis work that is supported by the National Commission of Gynecological Surgery and Urogynecology of Febrasgo.


 

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