Top

International Urogynecology Journal

Published in:

Open Access 01-10-2013 | Original Article

Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebo-controlled, randomized clinical trial

Authors: Robert Terlikowski, Bozena Dobrzycka, Maciej Kinalski, Anna Kuryliszyn-Moskal, Slawomir J. Terlikowski

Published in: International Urogynecology Journal | Issue 10/2013

Abstract

Introduction and hypothesis

The aim of this study was to evaluate the results of conservative treatment of urodynamic stress urinary incontinence (SUI) using transvaginal electrical stimulation with surface-electromyography-assisted biofeedback (TVES + sEMG) in women of premenopausal age.

Methods

One hundred and two patients with SUI were divided into two groups: active (n = 68) and placebo (n = 34) TVES + sEMG. The treatment lasted for 8 weeks and consisted of two sessions per day. Women were evaluated before and after the intervention by pad test, voiding diary, urodynamic test, and the Incontinence Quality of Life Questionnaire (I-QOL).

Results

Mean urinary leakage on a standard pad test at the end of 8th week was significantly lower in the active than the placebo group (19.5 ± 13.6 vs. 39.8 ± 28.5). Mean urinary leakage on a 24-h pad test was significantly reduced in the active group at the end of 8th and 16th weeks compared with the placebo group (8.2 ± 14.8 vs. 14.6 ± 18.9 and 6.1 ± 11.4 vs. 18.2 ± 20.8, respectively). There was also a significant improvement in muscle strength as measured by the Oxford scale in the active vs the placebo group after 8 and 16 weeks (4.2 vs 2.6 and 4.1 vs 2.7, respectively). No significant difference was found between groups in urodynamic data before and after treatment. At the end of 8th week, the mean I-QOL score in the active vs the placebo group was 78.2 ± 17.9 vs 55.9 ± 14.2, respectively, and at the end of 16th week 80.8 ± 24.1 vs. 50.6 ± 14.9, respectively.

Conclusion

Our study showed that TVES + sEMG is a trustworthy method of treatment in premenopausal women with SUI; however, its reliability needs to be established.

Sievert KD, Amend B, Toomey PA et al (2012) Can we prevent incontinence? ICI-RS 2011. Neurourol Urodyn 31(3):390–399PubMedCrossRef

Latthe PM, Foon R, Khan K (2008) Nonsurgical treatment of stress urinary incontinence (SUI): grading of evidence in systematic reviews. BJOG 115(4):435–444PubMedCrossRef

Coyne KS, Kvasz M, Ireland AM et al (2012) Urinary incontinence and its relationship to mental health and health-related quality of life in men and women in Sweden, the United Kingdom, and the United States. Eur Urol 61(1):88–95PubMedCrossRef

Liebergall-Wischnitzer M, Hochner-Celnikier D, Lavy Y et al (2009) Randomized trial of circular muscle versus pelvic floor training for stress urinary incontinence in women. J Womens Health (Larchmt) 18(3):377–385CrossRef

Dannecker C, Wolf V, Raab R et al (2005) EMG-biofeedback assisted pelvic floor muscle training is an effective therapy of stress urinary or mixed incontinence: a 7-year experience with 390 patients. Arch Gynecol Obstet 273(2):93–97PubMedCrossRef

Imamura M, Abrams P, Bain C et al (2010) Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technol Assess 14(40):1–188PubMed

Labrie J, van der Graaf Y, Buskens E et al (2009) Protocol for Physiotherapy Or TVT Randomised Efficacy Trial (PORTRET): a multicentre randomised controlled trial to assess the cost-effectiveness of the tension free vaginal tape versus pelvic floor muscle training in women with symptomatic moderate to severe stress urinary incontinence. BMC Womens Health 9:24PubMedCrossRef

Bø K, Hilde G (2012) Does it work in the long term?-A systematic review on pelvic floor muscle training for female stress urinary incontinence. Neurourol Urodyn. doi:10.1002/nau.22292

Caldwell KP (1963) The electrical control of sphincter incompetence. Lancet 2(7300):174–175PubMedCrossRef

10.

Fall M, Lindström S (1991) Electrical stimulation. A physiologic approach to the treatment of urinary incontinence. Urol Clin North Am 18(2):393–407PubMed

11.

Monga AK, Tracey MR, Subbaroyan J (2012) A systematic review of clinical studies of electrical stimulation for treatment of lower urinary tract dysfunction. Int Urogynecol J 23(8):993–1005PubMedCrossRef

12.

Schmidt AP, Sanches PR, Silva DP Jr et al (2009) A new pelvic muscle trainer for the treatment of urinary incontinence. Int J Gynaecol Obstet 105(3):218–222PubMedCrossRef

13.

Alves PG, Nunes FR, Guirro EC (2011) Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial. Rev Bras Fisioter 15(5):393–398PubMedCrossRef

14.

Castro RA, Arruda RM, Zanetti MR et al (2008) Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics (Sao Paulo) 63(4):465–472CrossRef

15.

Bø K (1998) Effect of electrical stimulation on stress and urge urinary incontinence. Clinical outcome and practical recommendations based on randomized controlled trials. Acta Obstet Gynecol Scand Suppl 168:3–11PubMed

16.

De Luca CJ (1997) The use of surface electromyography in biomechanics. J Appl Biomech 13:135–163

17.

Herderschee R, Hay-Smith EJ, Herbison GP et al (2011) Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev (7):CD009252

18.

Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17PubMedCrossRef

19.

Price DM, Noblett K (2012) Comparison of the cough stress test and 24-h pad test in the assessment of stress urinary incontinence. Int Urogynecol J 23(4):429–433PubMedCrossRef

20.

Wu WY, Sheu BC, Lin HH (2006) Comparison of 20-min pad test versus 1-h pad test in women with stress urinary incontinence. Urology 68(4):764–768PubMedCrossRef

21.

Painter V, Karantanis E, Moore KH (2012) Does patient activity level affect 24-h pad test results in stress-incontinent women? Neurourol Urodyn 31(1):143–147PubMedCrossRef

22.

Patrick DL, Martin ML, Bushnell DM et al (1999) Quality of life of women with urinary incontinence: further development of the Incontinence Quality of Life Instrument (I-QOL). Urology 53:71–76PubMedCrossRef

23.

Bushnell DM, Martin ML, Summers KH et al (2005) Quality of life of women with urinary incontinence: cross-cultural performance of 15 language versions of the I-QOL. Qual Life Res 14(8):1901–1913PubMedCrossRef

24.

Caruso DJ, Gomez CS, Gousse AE (2009) Medical management of stress urinary incontinence: is there a future? Curr Urol Rep 10(5):401–407PubMedCrossRef

25.

Holroyd-Leduc JM, Straus SE (2004) Management of urinary incontinence in women: scientific review. JAMA 291(8):986–995PubMedCrossRef

26.

Resplande J, Gholami S, Bruschini H et al (2003) Urodynamic changes induced by the intravaginal electrode during pelvic floor electrical stimulation. Neurourol Urodyn 22(1):24–28PubMedCrossRef

27.

Teague CT, Merrill DC (1977) Electric pelvic floor stimulation. Mechanism of action. Invest Urol 15(1):65–69PubMed

28.

Chai TC, Steers WD (1997) Neurphysiology of micturition and continence in women. Int Urogynecol Urol 8:85–97CrossRef

29.

Weatherall M (1999) Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta-analysis of trials identified in a systematic review. BJU Int 83(9):1015–1016PubMedCrossRef

30.

Gondin J, Guette M, Ballay Y et al (2006) Neural and muscular changes to detraining after electrostimulation training. Eur J Appl Physiol 97(2):165–173PubMedCrossRef

Title: Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebo-controlled, randomized clinical trial
Authors: Robert Terlikowski
Bozena Dobrzycka
Maciej Kinalski
Anna Kuryliszyn-Moskal
Slawomir J. Terlikowski
Publication date: 01-10-2013
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 10/2013
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-013-2071-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebo-controlled, randomized clinical trial

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2013

Levator myalgia: why bother?

The cube pessary: an underestimated treatment option for pelvic organ prolapse? Subjective 1-year outcomes

Comparison of two trocar-guided trans-vaginal mesh systems for repair of pelvic organ prolapse: a retrospective cohort study

The effect of obesity on fecal incontinence symptom distress, quality of life, and diagnostic testing measures in women

Comparison between trans-obturator trans-vaginal mesh and traditional anterior colporrhaphy in the treatment of anterior vaginal wall prolapse: results of a French RCT

Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 5-year prospective follow-up study