Does it work in the long term?-A systematic review on pelvic floor muscle training for female stress urinary incontinence

Aims There is level 1, grade A evidence that pelvic floor muscle training (PFMT) is effective in treatment of stress urinary incontinence (SUI), but long-term outcome has been questioned. The aim of this systematic review was to evaluate the long-term outcome of PFMT for female SUI. Methods Computerized search on PubMed up to year 2012 was undertaken with the search strategy: pelvic floor AND (urinary incontinence OR stress urinary incontinence) AND (training OR exercise OR physical activity) AND (follow-up OR long-term). Limitations were: humans, female, clinical trial, English, and adults. Inclusion criteria were: studies on SUI using PFMT with or without biofeedback as the intervention, follow-up period of 1 year. Exclusion criteria were studies using electrical stimulation alone and studies in the peripartum period. Results Nineteen studies were included (1,141 women followed between 1 and 15 years). Statistical meta-analysis was not performed due to high heterogeneity. Only two studies provided follow-up interventions. Losses to follow-up during the long-term period ranged between 0% and 39%. Long-term adherence to PFMT varied between 10% and 70%. Five studies reported that the initial success rate on SUI and MUI was maintained at long-term. Long-term success based on responders to the original trial varied between 41% and 85%. Surgery rates at long term varied between 4.9% and 58%. Conclusions Short-term outcome of PFMT can be maintained at long-term follow-up without incentives for continued training, but there is a high heterogeneity in both interventional and methodological quality in short-and long-term pelvic floor muscle training studies. Neurourol. Urodynam. 32: 215223, 2013. (c) 2012 Wiley Periodicals, Inc.