Weighted vaginal cones for urinary incontinence.

BACKGROUND: Pelvic floor muscle training has long been the most common form of conservative treatment for stress urinary incontinence. Many people have trouble identifying their pelvic floor, and thus difficulty training it. One aid to help with training the pelvic floor in women is weighted vaginal cones. These are inserted into the vagina and the pelvic floor is contracted to prevent them slipping out.

OBJECTIVES: To evaluate the effects of weighted vaginal cones in the treatment of female stress urinary incontinence.

SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (to December 1999), MEDLINE (January 1966 to November 1999), EMBASE (January 1988 to November 1999) and reference lists of relevant articles. Date of the most recent searches: December 1999.

SELECTION CRITERIA: The studies had to be randomised or quasi-randomised controlled trials. One arm of the study had to be the use of weighted vaginal cones. The women studied had to have stress urinary incontinence.

DATA COLLECTION AND ANALYSIS: Reports were assessed by all three reviewers to see if they complied with the inclusion/exclusion criteria. Data was abstracted by one reviewer and cross checked by the others. Included data were processed as described in the Cochrane Handbook.

MAIN RESULTS: Ten studies fitted the inclusion and exclusion criteria. 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. There was variation between studies in the ways cones were used and in the ways comparison treatments were given. Cones alone were compared with control, pelvic floor muscle training (PFMT), electrostimulation, PFMT plus cones, and electrostimulation plus PFMT. Cones in conjunction with PFMT were compared with PFMT alone and electrostimulation. Two of the studies recruited women with symptoms of incontinence while the others required that the women had urodynamically proven genuine stress incontinence. Outcome measures differed between studies, making the results difficult to combine. Some studies reported high drop out rates with some of these being related to treatment with cones. Overall the dropout rate was not much different to that in the comparison treatments. Cones were better than control treatment (cure or improvement RR 0. 38; 95% CI 0.23 to 0.63), and similar to PFMT (RR 1.23; 95% CI 0.78 to 1.94) and electrostimulation (RR 1.35; 95% CI 0.82 to 2.21). Cones plus PFMT was no different to either cones alone or PFMT alone. These results held for both subjective and objective outcomes, but the confidence intervals were wide.

REVIEWER'S CONCLUSIONS: This review provides limited evidence that weighted vaginal cones are beneficial in women with stress urinary incontinence. The limited data suggest that they are better than control treatments but similar to PFMT and electrostimulation. This conclusion must remain tentative until further larger high quality studies are carried out using similar relevant outcome measures. Some women treated with cones stop treatment early so cones may only be useful for those who find them acceptable.