Efficacy of transcutaneous perineal electrostimulation versus intracavitary anal electrostimulation in the treatment of urinary incontinence after a radical prostatectomy: Randomized controlled trial

Abstract

Aim To compare the efficacy of the treatment with transcutaneous perineal electrostimulation versus intracavitary electrostimulation to reduce the frequency of urinary incontinence after radical prostatectomy and the impact on the quality of life (QoL). Methods This single‐blind equivalence‐randomized controlled trial equally (1:1) randomly allocated men with urinary incontinence post radical prostatectomy into surface electrodes perineal group (intervention group, IG) and intra‐anal probe group (control group, CG). Outcomes included changes in the 24h‐Pad Test (main variable), and ICIQ‐SF (International Consultation on Incontinence Questionnaire Short‐Form), SF‐12 (Short Form Health Survey), and I‐QOL (incontinence quality of life questionnaire) questionnaires. Clinical data were collected at baseline, 6 and 10 weeks. For the comparisons between variables, χ2 test and Student's t test were used. Equivalence was analyzed by estimating the mean change (90% confidence interval) of urinary incontinence based on the Pad Test. The analysis was performed for the per‐protocol and the intention‐to‐treat populations. Statistical significance level was set at p < 0.05. Results Seventy patients were included, mean age 62.8 (SD 9.4) years. Mean baseline 24h‐Pad Test was 328.3 g (SD 426.1) and a significant decrease (p < 0.001) in the grams of urine loss at 5 weeks (159.1 g in the IG and 121.7 g in the CG), and at 10 weeks of treatment (248.5 g in the IG and 235.8 g in the CG) was observed. However, the final difference in the grams of urine loss between both treatments showed the absence of statistical significance (p = 0.874). In both groups, the ICIQ‐SF, I‐QOL, and SF‐12 questionnaires revealed a significant improvement in QoL. Conclusion Surface and intra‐anal electrostimulation treatments reduced significantly losses of urine, but differences in grams of urine loss throughout the therapy between groups were not significant, suggesting that the efficacy of the two treatments is not statistically different. Nonetheless, the improvement observed in both groups was statistically significant and clinically relevant.

Physiotherapy as an Effective Method to Support the Treatment of Male Urinary Incontinence: A Systematic Review

“…In most of the analyzed research protocols, electrostimulation was combined with other PFM therapeutic techniques [ 16 , 27 , 30 , 33 , 40 , 48 , 52 ] and lasted between 15 [ 16 , 31 , 40 , 52 ] and 20 min [ 27 , 33 , 34 ]. Ahmed et al [ 16 ] observed that UI therapy outcomes may improve after combining ES therapy with BF [ 16 ].…”

“…ES is most often combined with PFMT in the treatment of UI [ 27 , 30 , 31 , 40 , 48 ]. It has been shown that transcutaneous and anal electrostimulation when combined with PMFT significantly reduces UI symptoms in men after RP [ 40 ].…”

“…ES is most often combined with PFMT in the treatment of UI [ 27 , 30 , 31 , 40 , 48 ]. It has been shown that transcutaneous and anal electrostimulation when combined with PMFT significantly reduces UI symptoms in men after RP [ 40 ]. Soto-Gonzales et al [ 48 ] observed that the combination of BF with ES and PFMT home instruction significantly reduces UI symptoms and improves patients’ quality of life.…”

“…Gomes et al [ 27 ] noted that Pilates training or PFMT with ES significantly improved continence as compared to no postoperative rehabilitation [ 27 ]. If used in combination with PFMT, both transcutaneous perineal and anal electrostimulation have similar efficacy in the treatment of UI in men after RP [ 40 ]. The type of UI should first be determined to correctly select the therapy parameters [ 27 , 42 ].…”

“… RoB analysis ( n = 55). Low risk studies: [ 16 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], some concerns studies: [ 17 , 18 , 34 , 38 , 44 , 54 ], high risk studies [ 62 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , …”