Efficacy of pharmacological and non-pharmacological treatment of patients with cystocele

Abstract

In patients with cystocele, the effectiveness of conservative therapy is contradictory and does not allow making recommendations for clinical practice. The aim of the study was to evaluate the efficacy of combination therapy for patients with cystocele based on electrical stimulation of the pelvic floor muscles with biofeedback and fractional photothermolysis with a CO2‑laser, alone or in combination with medications (antimuscarinics and selective β3‑agonist). The prospective randomized study included 105 patients, of whom 60 had cystocele. The patients were divided into three groups: group 1 included the patients who underwent a course of electrical stimulation of the pelvic floor muscles and photothermolysis (with fractional CO2 laser) (Physiotherapy group); in group 2, the patients received a combination of physiotherapeutic exposure and pharmacological treatment (Combination group); in group 3, the patients received only pharmacological treatment (Pharmacology group). The stimulation of the pelvic floor muscles was carried out for 10 days, the fractional CO2‑laser was used 2 times, and pharmacological treatment continued for 3 months. The bladder diary was analyzed. In group 1 there were 25 patients with cystocele, in group 2–10 patients, in group 3–25 patients with cystocele. The indicators of the bladder diary improved significantly in all groups. Increasing the urinary flow rate was more effective with physiotherapy treatment, and reducing the frequency of urination was more efficient with drug therapy. The combination therapy was the most effective. The OAB-q SF score after 3 months may be a predictor of urination frequency less than 8 times per day 6 months after therapy, and the urinary flow rate greater than 14.5 ml / sec before treatment may be a predictor of a high urinary flow rate after 3 months of therapy. Thus, in women with cystocele, the effectiveness of physiotherapy is comparable to drug therapy, and the combination therapy contributes to a better result.