A Cochrane review [Abstract] 1 included 23 studies with a total of 1 806 participants. Cones were better than control treatment (failure to cure incontinence RR 0.84, 95% CI 0.76 to 0.94; 4 trials, n=375). There was little evidence of difference for a subjective cure between cones and PFMT (RR 1.01, 95% CI 0.91 to 1.13), or between cones and electrostimulation (RR 1.26, 95% CI 0.85 to 1.87), but the confidence intervals were wide.Seven of the trials recruited women with symptoms of incontinence, while the others required women with urodynamic stress incontinence, apart from one where the inclusion criteria were uncertain.
A prospective RCT 2 compared the use of tolterodine (4 mg/day) or weighted vaginal cones (WVC) in women with overactive bladder syndrome. 39 patients with urinary frequency (≥ 8/day), nocturia (≥ 2/night), urgency and a total score of ≥ 8 to the overactive bladder-awareness tool (OAB-V8) were included. A reduction of frequency, nocturia and urinary incontinence was observed in WVC group (p=0.006, p=0.034 and p=0.008, respectively) and in tolterodine group (p<0.001, p=0.002 and p=0.035, respectively). 24-h dry pad test results were improved significantly in both groups (p=0.003 and p=0.001, respectively). Pelvic muscle strength was significantly improved in WVC group but not in tolterodine group (p=0.010 and p=0.180, respectively). After treatment, detrusor overactivity (DO) resolved in 8 patients in the WVC group (p=0.003) and in 2 patients in the tolterodine group (p=0.426).
Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, blinding, incomplete outcome data, high loss to follow-up and, selective outcome reporting bias in over half of the studies).
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