Electrical stimulation for stress incontinence

Abstract

Electrical stimulation has been reported to be effective for stress incontinence, cure and improvement rates being reported to range from 30% to 50%, and from 6% to 90%, respectively. However, clinical application of this treatment is not common because there is little physiological and technical information. Electrodes for electrical stimulation are divided into two types: external (non-implantable) and internal (implantable), and there are two methods of stimulation: chronic (long-term, continuous) and short-term. Frequencies of 20-50 Hz, with a pulse duration of 1-5 ms, have been reported to be effective for urethral closure. The effectiveness of the treatment should be verified with placebo-controlled double-blinded trials, and four such studies using an active and a sham device have been reported. Two of these verified the superiority of the active device over the sham device, but the others did not demonstrate any significant difference between the two with regard to efficacy. Electrical stimulation has been reported to result in a long-term continuation of therapeutic effect. The effect has been explained as a re-education or a reactivation of lost functions of the pelvic floor muscles. As to adverse effects, there may be some complications in relation to anesthesia or surgical procedures, such as infection, pain and bleeding with implantable electrodes. The incidence of adverse effects in short-term electrical stimulation is less than 14%. In conclusion, short-term electrical stimulation using non-implantable anal or vaginal electrodes is the most recommendable because of safety and ease of use.

Neuromodulation for the Treatment of Lower Urinary Tract Symptoms

“…The mechanism of neuromodulation for SUI is contraction of the PFMs through an effect on the muscle fibers as well as through the stimulation of pudendal nerves. 1,33,34 Thus for the treatment of SUI, relatively high frequencies ranging from 20 to 50 Hz, with a pulse duration of 1-5 msec have been reported to be effective for urethral closure and PFM contraction. 25,26,35 However, there are several other protocols including stimulation at 12.5-100 Hz.…”

“…The vaginal electrode is most popular for women and usually cylinder-shaped, and the anal electrode, that is bullet-, or hourglass-shaped, is usually used for men to fit the anal canal and the sphincter. 22,33,34,37 Because intravaginal and anal plug electrode is intolerable for some patients due to pain, discomfort or mucosal injury, 22,33,34 surface electrodes stimulating the dorsal nerve of penis or clitoris has been used as a less invasive ES therapy for OAB (Transcutaneous electrical neurostimulation: TENS). 1,12,24,28 The electrodes were usually positioned at the S2-4 dermatome (perianal region), so that detrusor-mediated voiding is most influenced.…”

“…Cure and improvement rates in SUI have been reported to be 30-50 and 60-90%, respectively. 29,34 There were seven placebo (sham)-controlled RCTs for SUI, of which five showed significant superiority to placebo 33,37,77 -79 and two did not. 30,80 There were eight RCTs (including two RCTs for men with post prostatectomy incontinence) comparing the effects of PFMT and ES (Table 3).…”

Home exercises for pelvic floor in continent women one year after physical therapy treatment for urinary incontinence: an observational study

“…With appropriate physical therapy exercises this produces an improvement in symptoms up to 85% of cases 2,9 . Together with pelvic floor exercises, vaginal cones and endovaginal electro stimulation have produced up to 90% improvement not only in symptoms, but also in the quality of life of women with SUI 9,10 . Unfortunately, however, there are few public physical therapy services for incontinent women 11 .…”

Neuromodulation in Management of Overactive Bladder

“…Intravaginal and anal plug are sometimes intolerable for many patients due to discomfort, mucosal injury (Yamanishi et al, 1997;Yamanishi & Yasuda, 1998) and high intensity stimulation for acceptable outcome, surface electrodes like TENS have been employed as less invasive treatment for OAB.…”