The data support significant efficacy of combined PFMT and duloxetine in the treatment of women with SUI. We hypothesize that complementary modes of action of duloxetine and PFMT may result in an additive effect of combined treatment.

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Pelvic floor muscle training improves continence and increases vaginal pressure measurements, but the direct correlations between these alterations are weak. A woman's response to behavioral treatment does not depend on her demographic characteristics, clinical incontinence severity, urodynamic measures, or initial pelvic floor muscle strength.

The purpose of this study was to compare the effect of three conservative interventions: pelvic floor muscle training, bladder training, or both, on urodynamic parameters in women with urinary incontinence. Two hundred four women with genuine stress incontinence (GSI) or detrusor instability with or without GSI (DI ± GSI) participated in a two‐site trial comparing pelvic floor muscle training, bladder training, or both. Patients were stratified based on severity of urinary incontinence, urodynamic diagnosis, and treatment site, then randomized to a treatment group. All women underwent a comprehensive standardized evaluation including multi‐channel urodynamics at the initial assessment and at the end of 12 weeks of therapy. Analysis of covariance was used to detect differences among treatment groups on urodynamic parameters. Post‐treatment evaluations were available for 181 women. No differences were found among treatments on the following measurements: maximum urethral closure pressure, mean urethral closure pressure, maximum Kegel urethral closure pressure, mean Kegel urethral closure pressure, functional urethral length, pressure transmission ratios, straining urethral axis, first sensation to void, maximum cystometric capacity, and the MCC minus FSV. The effect of treatment did not differ by urodynamic diagnosis. Behavioral therapy had no effect on commonly measured urodynamic parameters. The mechanism by which clinical improvement occurs remains unknown. Neurourol. Urodynam. 18:427–436, 1999. © 1999 Wiley‐Liss, Inc.

Although most women with pelvic floor disorders are familiar with PMEs, less than one fourth could perform adequate contractions at the time of initial evaluation.

The aims of this study were to compare "subjective" measures of severity of urinary incontinence to similar "objective" measures, establish their statistical correlation, and determine the effect of specific urodynamic diagnosis on such correlations. Baseline data was available from 265 women entered into a clinical trial studying pharmacologic and behavioral interventions for urinary incontinence. The "subjective" measures of incontinence were obtained by patient recall during history taking and included: the number of incontinent episodes in 1 week, the number of perineal pads used during 1 week, and the number of clothing changes required due to wetness. The "objective" measures of severity included: the number of incontinent episodes per week as recorded on a 7-day diary, the number of perineal pads used per week, also recorded on a diary, and the amount of fluid lost during a standardized pad test. Analysis consisted of Pearson correlations and linear regressions to determine equations for the prediction of objective measurement on the basis of the corresponding subjective measure. Significant positive correlations were seen between "subjective" and "objective" measurements for the comparisons of number of weekly incontinent episodes (R = 0.63), and for the weekly number of pads used (R = 0.81). The comparison between the number of clothing changes and the amount of fluid lost during pad testing was also significantly but less strongly correlated (R = 0.24). For the correlations between subjective and objective determinations of urinary incontinent episodes and for those between clothing changes and pad testing, the urodynamic diagnosis had no effect on the correlation coefficients, but did have a statistically significant effect on the intercept.(ABSTRACT TRUNCATED AT 250 WORDS)

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