Long-Term Electrostimulation of the Pelvic Floor: Primary Therapy in Female Stress Incontinence?

Abstract

A prospective evaluation of the therapeutic effect of neuromuscular electrical pelvic floor stimulation was performed in 55 women with urinary stress incontinence awaiting surgical repair. Chronic stimulation was applied anally or vaginally by an integrated plug electrode for a median of 5.4 months. After therapy, 68% of the patients were continent or had improved so such that the planned operation was cancelled. At 2-year follow-up, the persisting success rate after electrostimulation was reduced to 56%, 31% had undergone surgical repair or were awaiting colposuspension, 9% were still incontinent, but refused surgery, and 4% were deceased. However, in the high-compliance group of 45 patients who had used the device regularly for at least 3 months, the success rate of pelvic floor stimulation was 72% at 2-year follow-up. The therapeutic effect could be verified objectively by positive changes in clinical stress test and dynamic urethral pressure profile. Approximately E 2,300 were saved for each patient avoiding surgery. A 40% reduction of the total cost of stress incontinence therapy was attained by the presented model.

Prevalence and risk factors of urinary incontinence in young and middle-aged women

“…However, as pure stress UI can be easily controlled, this was explored more speci®cally. Some have reported [29] that after 2 years of treatment, 56% of women presenting with stress UI are improved using only physiotherapy. Previous reports suggest that >70% of women treated with conventional surgery recover fully or are much improved after 5 years [28,30].…”

Transvaginal Electrical Stimulation in Female Genuine Stress Incontinence.

“…The reflex stimulation of pelvic nerves inhibits detrusor, regulates local blood flow, increases cognitive function and increases adrenergic activity while decreasing cholinergic activity 1,17,[19][20][21] . Delay in the reaction of pelvic floor reflexes and/or weakness of the pelvic floor muscles can cause stress incontinence so the electrical stimulation of the pelvic floor may restore the neuromuscular activity 5) . Since the current spreads, more motor units can be affected and a stronger contraction can be obtained 5) .…”

“…Even though genuine stress incontinence is often treated surgically, the use of rehabilitation methods are increasing in use. Pelvic floor exercises, biofeedback and pelvic floor muscle are some of the conservative methods advised for adult urinary stress incontinence before invasive procedures 4,5) . It has been reported that electrical stimulation may be an effective alternative method to surgical treatment with success rates of 6-90% in the treatment of genuine stress incontinence, but it has not been widely used because of a lack of knowledge about its physiology and technical principles [5][6][7] .…”

“…Pelvic floor exercises, biofeedback and pelvic floor muscle are some of the conservative methods advised for adult urinary stress incontinence before invasive procedures 4,5) . It has been reported that electrical stimulation may be an effective alternative method to surgical treatment with success rates of 6-90% in the treatment of genuine stress incontinence, but it has not been widely used because of a lack of knowledge about its physiology and technical principles [5][6][7] . There are some different reports about the daily treatment numbers, and the application time of the device 4) .¨ ˆ ¨¨ ˆ ¸ The aim of this study was to assess the efficacy of transvaginal electrical stimulation in genuine stress incontinence.…”

Physical therapy treatment in incontinent women provided by a Public Health Service

“…(56) observed the effectiveness of the mixed UI therapy using medications to reduce overactive bladder together with a pelvic floor rehabilitation program. The use of ES can improve symptoms (33,57,58) up to 77% and may provide a 40% reduction in costs if performed instead of surgery. Regardless of the technique employed, we found (Tables 5 and 6) a high success rate in this treatment, which provided data increasing the reliability of this therapy.…”