Electrical Stimulation for Urinary Incontinence in Women: A Systematic Review

Abstract

Background: Electrical stimulation is commonly recommended to treat urinary incontinence in women. It includes several techniques that can be used to improve stress, urge, and mixed symptoms. However, the magnitude of the alleged benefits is not completely established. Objectives: To determine the effects of electrical stimulation in women with symptoms or urodynamic diagnoses of stress, urge, and mixed incontinence. Search Strategy: Our review included articles published between January 1980 and January 2012. We used the search terms "urinary incontinence", "electrical stimulation", "intravaginal", "tibial nerve" and "neuromodulation" for studies including female patients. Selection Criteria: We evaluated randomized trials that included electrical stimulation in at least one arm of the trial, to treat women with urinary incontinence. Data Collection and Analysis: Two reviewers independently assessed the data from the trials, for inclusion or exclusion, and methodological analysis. Main Results: A total of 30 randomized clinical trials were included. Most of the trials involved intravaginal electrical stimulation. Intravaginal electrical stimulation showed effectiveness in treating urge urinary incontinence, but reported contradictory data regarding stress and mixed incontinence. Tibial-nerve stimulation showed promising results in randomized trials with a short follow-up period. Sacral-nerve stimulation yielded interesting results in refractory patients. Conclusions: Tibial-nerve and intravaginal stimulation have shown effectiveness in treating urge urinary incontinence. Sacral-nerve stimulation provided benefits in refractory cases. Presently available data provide no support for the use of intravaginal electrical stimulation to treat stress urinary incontinence in women. Further randomized trials are necessary to determine the magnitude of benefits, with long-term follow-up, and the effectiveness of other electrical-stimulation therapies.

Intracavitary electrical stimulation as treatment for overactive bladder: systematic review

“…Reduction of frequency, urinary incontinence and number of pads used also occurred, besides the improvement in urodynamic data. Such reductions and improvements were also found in other studies (4,12,13,20,23,31,33,34). Brubacker (24) reports that "There is good evidence that the use of vaginal electrical stimulators can reduce the occurrence of symptoms of overactive bladder in about half of the patients treated".…”

“…The precise mechanism is not well understood yet, but researchers believe that the mechanism of action of this therapy is associated with reorganization of spinal re lex and regulation of cortex activity (23). Usually, the pontine micturition center is responsible for the central control of micturition and its peripheral control is given by neurotransmitters and nerve ibers that regulate the bladder, urethra and periurethral region (6).…”

Fisioterapia en incontinencia urinaria de embarazo y posparto: una revisión sistemática

“…A partir de este último estudio, Schreiner et al confirman que la electroestimulación aislada como tratamiento de la IUE no es significativamente eficaz de forma aislada, sí lo es en la IUU y la IUM 26 .…”

A Different Option for Neuromodulation Procedures: Sacral Nerve Stimulation

“…In another meta-analysis regarding nonobstructive urinary retention, 14 studies were investigated, of which only one was randomized and 13 were observational; in addition, sacral modulation was concluded to be an effective method (30). In another meta-analysis in which only female patients were included, 30 randomized studies that included intravaginal stimulation, tibial nerve stimulation, and sacral neuromodulation as different treatment options were examined and sacral stimulation was demonstrated to be an effective method in resistant cases (31). The need for further studies has been stated in all of these studies, although the safety and efficacy of sacral neuromodulation in the treatment of urinary dysfunctions were observed.…”