Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebo-controlled, randomized clinical trial

Robert Terlikowski, Bozena Dobrzycka, Maciej Kinalski, Anna Kuryliszyn-Moskal, Slawomir J Terlikowski, Robert Terlikowski, Bozena Dobrzycka, Maciej Kinalski, Anna Kuryliszyn-Moskal, Slawomir J Terlikowski

Abstract

Introduction and hypothesis: The aim of this study was to evaluate the results of conservative treatment of urodynamic stress urinary incontinence (SUI) using transvaginal electrical stimulation with surface-electromyography-assisted biofeedback (TVES + sEMG) in women of premenopausal age.

Methods: One hundred and two patients with SUI were divided into two groups: active (n = 68) and placebo (n = 34) TVES + sEMG. The treatment lasted for 8 weeks and consisted of two sessions per day. Women were evaluated before and after the intervention by pad test, voiding diary, urodynamic test, and the Incontinence Quality of Life Questionnaire (I-QOL).

Results: Mean urinary leakage on a standard pad test at the end of 8th week was significantly lower in the active than the placebo group (19.5 ± 13.6 vs. 39.8 ± 28.5). Mean urinary leakage on a 24-h pad test was significantly reduced in the active group at the end of 8th and 16th weeks compared with the placebo group (8.2 ± 14.8 vs. 14.6 ± 18.9 and 6.1 ± 11.4 vs. 18.2 ± 20.8, respectively). There was also a significant improvement in muscle strength as measured by the Oxford scale in the active vs the placebo group after 8 and 16 weeks (4.2 vs 2.6 and 4.1 vs 2.7, respectively). No significant difference was found between groups in urodynamic data before and after treatment. At the end of 8th week, the mean I-QOL score in the active vs the placebo group was 78.2 ± 17.9 vs 55.9 ± 14.2, respectively, and at the end of 16th week 80.8 ± 24.1 vs. 50.6 ± 14.9, respectively.

Conclusion: Our study showed that TVES + sEMG is a trustworthy method of treatment in premenopausal women with SUI; however, its reliability needs to be established.

Figures

Fig. 1
Fig. 1
Recruitment and progress of participants throughout the trial

References

    1. Sievert KD, Amend B, Toomey PA, et al. Can we prevent incontinence? ICI-RS 2011. Neurourol Urodyn. 2012;31(3):390–399. doi: 10.1002/nau.22225.
    1. Latthe PM, Foon R, Khan K. Nonsurgical treatment of stress urinary incontinence (SUI): grading of evidence in systematic reviews. BJOG. 2008;115(4):435–444. doi: 10.1111/j.1471-0528.2007.01629.x.
    1. Coyne KS, Kvasz M, Ireland AM, et al. Urinary incontinence and its relationship to mental health and health-related quality of life in men and women in Sweden, the United Kingdom, and the United States. Eur Urol. 2012;61(1):88–95. doi: 10.1016/j.eururo.2011.07.049.
    1. Liebergall-Wischnitzer M, Hochner-Celnikier D, Lavy Y, et al. Randomized trial of circular muscle versus pelvic floor training for stress urinary incontinence in women. J Womens Health (Larchmt) 2009;18(3):377–385. doi: 10.1089/jwh.2008.0950.
    1. Dannecker C, Wolf V, Raab R, et al. EMG-biofeedback assisted pelvic floor muscle training is an effective therapy of stress urinary or mixed incontinence: a 7-year experience with 390 patients. Arch Gynecol Obstet. 2005;273(2):93–97. doi: 10.1007/s00404-005-0011-4.
    1. Imamura M, Abrams P, Bain C, et al. Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technol Assess. 2010;14(40):1–188.
    1. Labrie J, van der Graaf Y, Buskens E, et al. Protocol for Physiotherapy Or TVT Randomised Efficacy Trial (PORTRET): a multicentre randomised controlled trial to assess the cost-effectiveness of the tension free vaginal tape versus pelvic floor muscle training in women with symptomatic moderate to severe stress urinary incontinence. BMC Womens Health. 2009;9:24. doi: 10.1186/1472-6874-9-24.
    1. Bø K, Hilde G (2012) Does it work in the long term?-A systematic review on pelvic floor muscle training for female stress urinary incontinence. Neurourol Urodyn. doi:10.1002/nau.22292
    1. Caldwell KP. The electrical control of sphincter incompetence. Lancet. 1963;2(7300):174–175. doi: 10.1016/S0140-6736(63)92807-1.
    1. Fall M, Lindström S. Electrical stimulation. A physiologic approach to the treatment of urinary incontinence. Urol Clin North Am. 1991;18(2):393–407.
    1. Monga AK, Tracey MR, Subbaroyan J. A systematic review of clinical studies of electrical stimulation for treatment of lower urinary tract dysfunction. Int Urogynecol J. 2012;23(8):993–1005. doi: 10.1007/s00192-012-1691-5.
    1. Schmidt AP, Sanches PR, Silva DP, Jr, et al. A new pelvic muscle trainer for the treatment of urinary incontinence. Int J Gynaecol Obstet. 2009;105(3):218–222. doi: 10.1016/j.ijgo.2009.01.013.
    1. Alves PG, Nunes FR, Guirro EC. Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial. Rev Bras Fisioter. 2011;15(5):393–398. doi: 10.1590/S1413-35552011005000010.
    1. Castro RA, Arruda RM, Zanetti MR, et al. Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics (Sao Paulo) 2008;63(4):465–472. doi: 10.1590/S1807-59322008000400009.
    1. Bø K. Effect of electrical stimulation on stress and urge urinary incontinence. Clinical outcome and practical recommendations based on randomized controlled trials. Acta Obstet Gynecol Scand Suppl. 1998;168:3–11.
    1. De Luca CJ. The use of surface electromyography in biomechanics. J Appl Biomech. 1997;13:135–163.
    1. Herderschee R, Hay-Smith EJ, Herbison GP et al (2011) Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev (7):CD009252
    1. Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–17. doi: 10.1016/S0002-9378(96)70243-0.
    1. Price DM, Noblett K. Comparison of the cough stress test and 24-h pad test in the assessment of stress urinary incontinence. Int Urogynecol J. 2012;23(4):429–433. doi: 10.1007/s00192-011-1602-1.
    1. Wu WY, Sheu BC, Lin HH. Comparison of 20-min pad test versus 1-h pad test in women with stress urinary incontinence. Urology. 2006;68(4):764–768. doi: 10.1016/j.urology.2006.04.018.
    1. Painter V, Karantanis E, Moore KH. Does patient activity level affect 24-h pad test results in stress-incontinent women? Neurourol Urodyn. 2012;31(1):143–147. doi: 10.1002/nau.21169.
    1. Patrick DL, Martin ML, Bushnell DM, et al. Quality of life of women with urinary incontinence: further development of the Incontinence Quality of Life Instrument (I-QOL) Urology. 1999;53:71–76. doi: 10.1016/S0090-4295(98)00454-3.
    1. Bushnell DM, Martin ML, Summers KH, et al. Quality of life of women with urinary incontinence: cross-cultural performance of 15 language versions of the I-QOL. Qual Life Res. 2005;14(8):1901–1913. doi: 10.1007/s11136-005-5266-5.
    1. Caruso DJ, Gomez CS, Gousse AE. Medical management of stress urinary incontinence: is there a future? Curr Urol Rep. 2009;10(5):401–407. doi: 10.1007/s11934-009-0063-2.
    1. Holroyd-Leduc JM, Straus SE. Management of urinary incontinence in women: scientific review. JAMA. 2004;291(8):986–995. doi: 10.1001/jama.291.8.986.
    1. Resplande J, Gholami S, Bruschini H, et al. Urodynamic changes induced by the intravaginal electrode during pelvic floor electrical stimulation. Neurourol Urodyn. 2003;22(1):24–28. doi: 10.1002/nau.10062.
    1. Teague CT, Merrill DC. Electric pelvic floor stimulation. Mechanism of action. Invest Urol. 1977;15(1):65–69.
    1. Chai TC, Steers WD. Neurphysiology of micturition and continence in women. Int Urogynecol Urol. 1997;8:85–97. doi: 10.1007/BF02764824.
    1. Weatherall M. Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta-analysis of trials identified in a systematic review. BJU Int. 1999;83(9):1015–1016. doi: 10.1046/j.1464-410x.1999.00091.x.
    1. Gondin J, Guette M, Ballay Y, et al. Neural and muscular changes to detraining after electrostimulation training. Eur J Appl Physiol. 2006;97(2):165–173. doi: 10.1007/s00421-006-0159-z.

Source: PubMed

3
订阅