Evaluation of Neuromuscular Electrical Stimulation in the Treatment of Genuine Stress Incontinence

Abstract

Summary Objectives The purpose of this clinical trial was to evaluate the effectiveness of acute maximal clinic-based and chronic low-intensity home-based neuromuscular electrical stimulation in the treatment of genuine stress incontinence in women. For the purpose of this article these will be referred to as clinic and home treatments. As these treatments are often applied in combination with pelvic floor exercises and biofeedback, the two types of electrotherapy were evaluated within a combination therapy programme. Study design A prospective randomised controlled clinical trial was conducted, with 70 women aged 24–68, who had urodynamically proven genuine stress incontinence, referred for treatment in the department of urotherapy. The control group received a six-month treatment programme of pelvic floor exercises and biofeedback. The two treatment groups received, in addition, either home or clinic vaginal electrical stimulation. The primary outcome measures were the amount of urine loss determined by pad-testing, and the patients' subjective appraisal of their condition. Results A total of 57 women completed the trial and these sets of data were used for analysis to evaluate the effect of electrotherapy on subjects who received that treatment. Results were also evaluated on an intent-to-treat basis; 61% were subjectively greatly improved or cured, and 64% had a reduction in urine loss of 75% or more at pad-testing. There were no statistically significant differences in outcome measures between the three groups. However, the greatest percentage of subjects greatly improved or cured subjectively (80%) and by pad-test (80%), were in the maximal stimulation group (n = 20). Subjects who received home stimulation had a lower success rate than either the clinic treatment or the control group. Conclusions Pelvic floor exercises and biofeedback alone are an effective treatment for genuine stress incontinence. Women with a long history of symptoms or previous ineffective incontinence surgery, may benefit from the addition of maximal vaginal stimulation. The addition of low intensity stimulation to a pelvic floor exercise programme appeared to have a detrimental influence on the women's progress.