Efficacy of pelvic floor muscle exercise or therapy with or without duloxetine: a systematic review and network Meta-analysis

Postprostatectomy urinary incontinence (PPUI) is a serious complication despite surgical advances. Treatment options for PPUI include conservative care like Pelvic floor muscle exercise (PFME), which is a physiotherapy performed by the patients themselves; Pelvic floor muscle therapy (PFMT), a physiotherapy performed under the guidance of a therapist, and duloxetine treatment; and surgical interventions. In this study, network meta-analysis (NMA) was performed for direct comparison of these treatment options. The NMA pooled the odds ratios and 95% credible intervals using the number of patients achieving urinary continence and the total number of patients in an intention-to-treat population. The treatments were ranked based on the surface under the cumulative ranking curve (SUCRA) probabilities and the rankograms. The pooled overall ORs of patients achieving urinary continence compared with no treatment was 1.73 (95% CrI: 0.657, 4.71) in PFME, 2.62 (95% CrI: 0.553, 13.5) in PFME plus Duloxetine, and 4.05 (95% CrI: 1.70, 10.2) in PFMT. The SUCRA values of ranking probabilities for each treatment showed high rates of continence in the order of PFMT, PFME plus Duloxetine, and PFME. The results suggest that patients with PPUI should undergo PFMT and consider duloxetine as an additional treatment option.

前列腺术后尿失禁（Postprostatectomy urinary incontinence, PPUI）尽管手术技术不断进步，仍是一种严重的术后并发症。PPUI的治疗方案包括保守治疗与手术干预两类：保守治疗涵盖患者自行完成的物理治疗手段——盆底肌锻炼（Pelvic floor muscle exercise, PFME）、由治疗师指导实施的盆底肌治疗（Pelvic floor muscle therapy, PFMT），以及度洛西汀药物治疗；手术干预则为另一类治疗选择。本研究针对上述治疗方案开展了网络Meta分析（network meta-analysis, NMA），以直接比较各类疗法的优劣。本次网络Meta分析以意向治疗人群中达到尿控的患者例数与总患者数为依据，合并计算了比值比及95%可信区间，并基于累积排序曲线下面积（surface under the cumulative ranking curve, SUCRA）概率值与排序图（rankograms）对各治疗方案进行疗效排序。与未治疗组相比，各疗法实现尿控的合并总体比值比分别为：PFME组1.73（95% CrI：0.657, 4.71）、PFME联合度洛西汀组2.62（95% CrI：0.553, 13.5）、PFMT组4.05（95% CrI：1.70, 10.2）。各治疗方案的SUCRA排序概率值显示，尿控达标率由高到低依次为PFMT、PFME联合度洛西汀、PFME。本研究结果提示，PPUI患者应优先接受PFMT治疗，并可将度洛西汀作为联合治疗方案予以考虑。