Treinamento vesical isolado ou em combinação com outras terapias na melhora dos sintomas da bexiga hiperativa : uma revisão sistemática com metanálise de ensaios clínicos randomizados controlados

Abstract

Background: Bladder training (BT) is characterized by a scheduled voiding regime with gradually adjusted voiding intervals and is commonly used conservative treatment for individuals with overactive bladder (OAB). Objectives: To present a systematic review with meta-analysis of randomized controlled trials regarding BT isolated and/or in combination with other therapies to improve OAB symptoms. Materials and Methods: A systematic review was conducted in eight databases: PubMed, PEDro, SciELO, LILACS, Cochrane Library, Web of Science, EMBASE, CINAHL. After screening titles, abstracts and full texts are retrieved. Fourteen randomized controlled trials (RCTs) were included and the Cochrane RoB 2 and GRADE system were used. Results: Fourteen randomized controlled trials (RCTs) were included: BT isolated (n=11), BT+ drug treatment (DT) (n=5), BT+ intravaginal electrical stimulation (IVES) (n=2), BT+ biofeedback (BF)+IVES (n=1), BT+ pelvic floor muscle training (PFMT)+ behavioral advice/lifestyle (BA) (n=2), BT+ percutaneous tibial nerve stimulation

(PTNS), and BT+ transcutaneous tibial nerve stimulation (TTNS) (n=1). After meta- analysis at short-term follow-up, BT+IVES improved nocturia (MD:0.89, 95%, CI:0.59-

1.20), urinary incontinence (UI) (MD:1.93, 95%, CI:1.32-2.55), and quality of life (QoL) (MD:4.87, 95%, CI:2.24-7.50); for BT versus DT, DT promoted improvement in UI (MD:0.58, 95%, CI:0.23-0.92), and no significant results were found for mid-long-term follow-up. Conclusions: BT+IVES showed favorable results for the treatment of BH in the short-term follow-up period, while BT isolated did not show favorable results. The use of BT+IVES is recommended as a useful conservative therapeutic strategy for the treatment of individuals with OAB. However, the heterogeneity and low methodological quality found present in the RCTs found suggests that new studies should be performed, and in this regard, the findings of this review should be analyzed with caution.