Electrical stimulation versus pelvic floor muscle training for female urinary incontinence: A systematic review with meta-analysis

Abstract

Introduction: Female urinary incontinence is a prevalent clinical condition characterized by involuntary urine loss and a significant impact on quality of life; pelvic floor muscle training (PFMT) is the cornerstone of conservative treatment, and electrostimulation therapies have been incorporated as complementary strategies. Objective: To describe the effects of electrical stimulation, either alone or combined with pelvic floor muscle training (PFMT), compared to training alone, regarding clinical and functional improvement in female urinary incontinence. Methods: A systematic review with meta-analysis was conducted, searching the LILACS/VHL (Latin American and Caribbean Health Sciences Literature/Virtual Health Library), SciELO (Scientific Electronic Library Online), and PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) databases. Randomized controlled trials published between 2021 and 2026 were included; risk of bias was assessed using the RoB 2 tool, and data were synthesized using a random-effects model, with heterogeneity estimated by I². Results: Seven randomized controlled trials were included, totaling approximately 371 women with various types of urinary incontinence. Most individual studies favored the active interventions; however, the combined effect was not statistically significant (standardized mean difference [SMD] = −0.15; 95% CI −1.59 to 1.29), amidst very high heterogeneity (I² = 90.8%). Conclusion: Electrostimulation, whether alone or combined with PFMT, showed promising clinical results in individual studies, but the combined effect did not reach statistical significance; larger, standardized trials are needed before recommending it as superior to PFMT alone.