Pelvic Floor Electrical Stimulation Research Articles

The National Coverage Decision for Reimbursement for Biofeedback and Pelvic Floor Electrical Stimulation for Treatment of Urinary Incontinence

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Limbic and somatic cortex activations in electrical pelvic floor stimulation

Limbic and somatic cortex activations in electrical pelvic floor stimulation

Pelvic Floor Electrical Stimulation for Genuine Stress Incontinence: Who Will Benefit and When?

This study sought to determine the characteristics of women in whom pelvic floor electrical stimulation will reduce stress urinary incontinence. It also evaluates how long electrical stimulation should be used before significant improvements are seen in clinical outcomes. Subjects with genuine stress incontinence were enrolled into a multicenter non-randomized trial. They used electrical stimulation for 15 minutes twice daily or every other day for 20 weeks. At the end of 20 weeks, those with a 50% reduction in leakage episodes on voiding diary (‘responders’) were compared with those who did not show a 50% reduction (‘non-responders’). Thirty-one subjects were enrolled and 28 completed the study. After the treatment period, 19 subjects were defined as responders and 9 as non-responders. There were no significant differences between the two groups in baseline demographics (e.g. age, parity, largest birth weight etc.) other than body mass index (greater in nonresponders). Significant subjective and objective improvements were noted among responders by 10 and 14 weeks, respectively. Compliance was higher in responders during weeks 12–15 of the study (P=0.05). It was concluded that a minimum of 14 weeks of pelvic floor stimulation was necessary before significant objective improvements were seen. Body mass index and patient compliance may affect success.

Pelvic floor electrical stimulation for the treatment of urge and mixed urinary incontinence in women

Objectives To determine the efficacy of daily or every-other-day electrical stimulation in treating detrusor instability (urge) or urge plus genuine stress (mixed) urinary incontinence in women. Methods A multicenter, prospective, nonrandomized study enrolled subjects with urge and mixed urinary incontinence assigned to daily or every-other-day treatments (15 minutes twice daily) using pelvic floor stimulation. Outcome measures assessed were (1) leakage episodes, nocturnal episodes, voiding frequency, total voids, and pad count, and (2) patient subjective assessment and quality of life. Results Seventy-two subjects were enrolled. Sixty-eight subjects completed the 20-week protocol: 33 treated daily and 35 treated every other day. The entire study group (n = 68) experienced a significant decrease in total leaks ( P < 0.001), nocturnal episodes ( P = 0.001), pad count ( P = 0.002), and total voids ( P = 0.003) and on visual analog scales. Sixty-nine percent (n = 46) of subjects with urge or mixed incontinence were cured or improved by at least 50%, with 28% (n = 19) being cured. There were no significant differences between daily and every-other-day users. Nonresponse was correlated with number of previous therapies ( P < 0.001 ) and number of vaginal deliveries ( P = 0.007). Overall, subjects were 93% compliant with device use, and 72% (n = 47) were satisfied with the therapy. Conclusions Twenty weeks of pelvic floor electrical stimulation therapy is effective in treating urge and mixed urinary incontinence, regardless of daily or every-other-day treatments.

Nonoperative management of urinary incontinence

Recent public health policies emphasize managing urinary incontinence nonoperatively, rather than proceeding directly to surgery. Advantages of this approach include decreased cost and risk. Additionally, incontinence treatment becomes accessible to many more women, by expanding care to nonspecialists. This article reviews data published in the past 18-24 months pertaining to conservative management of incontinence. Specific modalities reviewed include pelvic floor muscle exercises, electrical stimulation, medication, vaginal devices, and bladder training.

Pelvic floor electrical stimulation: a comparison of daily and every-other-day therapy for genuine stress incontinence

Objectives. To compare the effectiveness of daily and every-other-day electrical stimulation in treating genuine stress incontinence. Methods. Subjects with genuine stress incontinence were enrolled in a multicenter, prospective, nonrandomized study and underwent daily or every-other-day pelvic floor stimulation treatments for 15 minutes twice a day. Outcome measures assessed were (1) leakage episodes and pad count; (2) leakage amount, and (3) subject subjective assessment and quality of life. Thirteen subjects treated daily and 15 treated every other day completed the 20-week protocol. One-year follow-up data were available for 21 subjects. Results. No significant differences in primary outcome variables were found between the groups. Subjects treated every other day had significant decreases in total leakage episodes ( P = 0.04), pad count ( P = 0.04), total voids ( P = 0.02), and visual analog scale scores, with stress incontinence cured or improved by 50% in 73% (n = 11). Subjects treated every day had significant decreases in urge episodes ( P = 0.03), pad count ( P = 0.05), and visual analog scale scores, with 62% (n = 8) cured or improved by 50%. Compliance was higher for subjects treated every other day ( P = 0.05). Satisfaction with therapy was 75% (n = 10) for daily treatment and 77% (n = 12) for every-other-day treatment. At 1 year, 70% (n = 7) of subjects who continued device use maintained their cure or improvement status. Conclusions. Both daily and every-other-day therapy with pelvic floor electrical stimulation are effective in treating genuine stress incontinence. Subjects who continue device use maintain a higher cure or improvement rate.

Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: A multicenter, placebo-controlled trial

OBJECTIVE: Our purpose was to determine the efficacy of transvaginal electrical stimulation in treating genuine stress incontinence. STUDY DESIGN: This was a multicenter, prospective, randomized, double-blinded, placebo-controlled 15-week trial comparing the use of an active pelvic floor stimulator with a sham device. Thirty-five women used an active unit and 17 control subjects used sham devices. Weekly and daily voiding diaries were recorded throughout the trial. Urodynamic testing, including pad test and subtracted cystometry, was done before and at the end of device use. Pelvic muscle strength was measured at baseline and at the end of the trial. Patients scored their symptoms on visual analog scales and completed quality-of-life questionnaires before and after therapy. RESULTS: Significant improvements from baseline were found in patients using active devices but not in controls. Comparisons of changes from baseline between active-device and control patients showed that active-device patients had significantly greater improvement in weekly ( p = 0.009) and daily ( p = 0.04) leakage episodes, pad testing ( p = 0.005), and vaginal muscle strength ( p = 0.02) when compared with control subjects. Significantly greater improvement was also found for both visual analog scores of urinary incontinence ( p = 0.007) and stress incontinence ( p = 0.02), as well as for subjective reporting of frequency of urine loss ( p = 0.002), and urine loss with sneezing, coughing, or laughing ( p = 0.02), when compared with controls. Pad testing showed that stress incontinence was improved by at least 50% in 62% of patients using an active device compared with only 19% of patients using sham devices ( p = 0.01). Voiding diaries showed at least 50% improvement in 48% of active-device patients compared with 13% of women using the sham device ( p = 0.02). No irreversible adverse effects were noted in either group. CONCLUSIONS: Transvaginal pelvic floor electrical stimulation was found to be a safe and effective therapy for genuine stress incontinence.

Multimodality pelvic physiotherapy treatment of urinary incontinence in adult women

The aim of the study was to evaluate the effectiveness of in-office physiotherapy for stress, mixed and urge incontinence. All subjects underwent urodynamics. Those with stress incontinence received pressure biofeedback pelvic floor exercises and electrical stimulation. Those with detrusor instability and mixed incontinence received bladder drills, anticholinergic medications, electrical stimulation and pressure biofeedback pelvic floor exercises. All those with atrophic vaginitis received vaginal estrogen. Weekly treatment sessions for 4 weeks and then monthly for 2 months were directed by a trained gynecologic nurse. Weekly bladder diaries were kept. Outcome measures included diary-recorded incontinence episodes and subjective reporting of continence. One hundred and four women completed the program. Weekly incontinence episodes decreased from 22 to 2 (<0.05) in both stress and detrusor instability/mixed incontinence groups. An average of 4.5 sessions over 6.1 weeks was necessary for optimal response; 86% reported subjective improvement. It was concluded that multimodality treatment of incontinence leads to a 90% reduction in incontinence episodes. The relative contribution of each treatment modality requires further study.

Reduction in Norepinephrine Content of the Rabbit Urinary Bladder by Alpha-2 Adrenergic Antagonist after Electrical Pelvic Floor Stimulation

The present study was designed to obtain evidence of reflex activation of the hypogastric nerves during electrical pelvic floor stimulation. Rabbits were treated with yohimbine (900μg./kg./min.) with and without electrical stimulation under general anesthesia. Norepinephrine (NE) content of the rabbit bladder body and base were estimated by high performance liquid chromatography. Administration of yohimbine alone reduced the NE content of the bladder base (p<0.05). The combination of yohimbine and electrical pelvic floor stimulation decreased NE content in the bladder base to a greater extent (p<0.001); NE content in the bladder body decreased slightly (p<0.001). Here we present evidence that the hypogastric nerves are reflexively activated by stimulation of the pelvic floor structures.

Analysis of Regional Norepinephrine Content in the Rabbit Bladder after Acute Electrical Pelvic Floor Stimulation

Experiments were carried out to evaluate the regional norepinephrine (NE) content of the rabbit bladder after acute electrical pelvic floor stimulation (EPFS). After 30 minutes of EPFS, the content of NE increased significantly in both the bladder base and body (p < 0.05). Furthermore, this increased NE content continued for 1 to 2hours after cessation of stimulation. The content of NE in the bladder base and body in rabbits treated with alpha-methyl-paratyrosine (AMT) was lower than in the control group. Application of EPFS increased NE content in the bladder even in animals pretreated with AMT. Based on these findings, during EPFS the hypogastric nerve would be presumed to play a significant role in bladder inhibition. Increased synthesis of NE probably did not play an important role in elevation of NE content after EPFS.

Technique of percutaneous electrode implantation for electrical pelvic floor stimulation.

A modified technique of electrical pelvic floor stimulation is described in detail. Six patients suffering from detrusor urinary incontinence underwent percutaneous electrode implantation for electrical pelvic floor stimulation. By this procedure adequate muscle contraction was obtained with a significant rise in urethral closure pressure. Detrusor reflex thresholds were increased in 5 of 6 patients at the initial stimulation. Percutaneous implantation appears to be an easy and noninvasive technique. This method provides stable and adequate effects on the pelvic floor structure and may be used in chronic electrical stimulation.

Maximal electrical stimulation of patients with frequency, urgency and urge incontinence. Report of 38 cases.

Thirty-eight consecutive female patients with frequency, urgency or urge incontinence were treated with maximal electrical pelvic floor stimulation. Diagnostic cystometry was performed in 34 cases. Detrusor instability was found in 13 patients, sensory urgency in 13 and hyperreflexia in eight cases. The effect of the treatment was evaluated by subjective assessment and micturition charts filled in for 48 hours. 63% were cured or improved. The success rate was the same among elderly and younger patients. Detrusor instability and hyperreflexia improved in about 75% of the cases. A good correlation was found between the subjective assessment and the micturition chart recordings. Maximal electrical stimulation has a good effect on certain types of lower urinary tract dysfunction with few side-effects. It is well tolerated even by elderly patients.

Long-term electrostimulation of the pelvic floor: primary therapy in female stress incontinence?

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 2,300 pounds were saved for each patient avoiding surgery. A 40% reduction of the total cost of stress incontinence therapy was attained by the presented model.

Electrical pelvic floor stimulation for the control of detrusor instability

AbstractExperimental and clinical investigations have shown that pelvic floor electrical stimulation activates the striated paraurethral musculature and evokes inhibitory segmental reflexes with abolition of bladder hyperactivity. In the early clinical series, the methods were designed for stress incontinence but urge symptoms have later turned out to be the main indication for electrostimulation. The current clinical results of electrostimulation in detrusor instability are good. Electrostimulation seems to be one of the best options for detrusor instability alone or in combination with stress incontinence.

Urinary incontinence. Treatment with electrical stimulation of the pelvic floor.

Electrical pelvic floor stimulation may be administered either externally by the transrectal tampon or internally with the implantable pelvic floor stimulator. This treatment modality requires intact pelvic floor innervation and therefore is unsuccessful in patients with pelvic floor denervation. Pelvic floor stimulation has been successful in patients with stress and with congenital, iatrogenic, and postoperative urinary incontinence.