Methods
The
search strategy
used was developed
for the Cochrane
Incontinence Group.
Relevant
trials were identified
from the Group's
Specialised Register
of Controlled Trials
which is described
in the Cochrane
Library.
Several trials
were added from
the reviewers' knowledge
or extra searching.
Trials had to be randomised or quasi-randomised controlled trials. One arm of the study had to use weighted vaginal
cones.
The women
studied had to have
stress urinary incontinence.
Included
data were processed
as described in
the Cochrane Handbook
1.
Results
Ten
studies fitted the
inclusion and exclusion
criteria 2-11. Four of these have only been published as abstracts.
All of the
studies were small
and in many the
quality was hard
to judge. The studies tested seven comparisons, cones alone versus control,
pelvic floor muscle
training (PFMT),
electrostimulation,
PFMT plus cones
and electrostimulation
plus PFMT.
Cones in
conjunction with
PFMT were compared
to PFMT alone and
electrostimulation. Outcome measures differed between studies,
making the results
difficult to combine.
A moderate
proportion dropped
out of the treatment
with cones and this
was not much different
to the dropout proportion
in the comparison
treatments.
Cones
were better than
control treatment,
and similar to PFMT
and electrostimulation.
Cones plus
PFMT was no different
to either cones
alone or PFMT alone.
Conclusions
This
review provides
limited evidence
that weighted vaginal
cones are beneficial
in women with stress
urinary incontinence.
They are
better than control
treatments but similar
to PFMT and electrostimulation. However, the confidence intervals are such
that cones may be
much worse, or much
better than PFMT
or electrostimulation.
This conclusion
must remain tentative
until further larger
high quality studies
are carried out
using the same outcome
measures so their
results can be combined.
1.
Cochrane Collaboration
Handbook. Issue
4.
1997Update
Software. Oxford.
2.
BMJ 1999;318:487-93.
3. Euro J Obstet
Gynecol Reprod Biol
1998;77:89-93.
4. Neurourol Urodyn
1991;10:393-4.
5. Physiotherapy
1993;79:553-60.
6. Am J Obstet Gynecol
1990;162:87-92.
7. Neurourol Urodyn
1988;7:265-6.
8. Int Urogynecol
J 1995;6:14-7.
9. ICS Read by Title Abstracts
1996:248–9
10.
Int Urogynecol J
1998;9:257–64.
11.
Neurourol Urodyn
1993;12:436-7.
