Pelvic Floor Therapy Research Articles

Management of sexual dysfunction in breast cancer survivors: a systematic review.

Female sexual dysfunction occurs frequently in midlife breast cancer survivors (BCS) and encompasses problems with sexual desire, interest, arousal, orgasm and genitopelvic pain. Although common, sexual problems are under-diagnosed and under-treated in BCS. The objective of this review was to assess primary studies that intervene on sexual dysfunction in BCS. In February 2015, PubMed, SCOPUS, CINAHL, COCHRANE and Web of Science databases were systematically searched for randomized controlled clinical trials (RCTs) of vaginal (lubricants, moisturizers, estrogens, dehydroepiandrosterone [DHEA], testosterone, vibrators, dilators), systemic (androgens, anti-depressants, flibanserin, ospemifene), physical therapy (physical activity, pelvic floor training), counseling and educational interventions on sexual function in BCS. Observational studies of vaginal interventions were also included due to the paucity of RCTs. The search yielded 1414 studies, 34 of which met inclusion criteria. Both interventions and outcomes, measured by 31 different sexual function scales, were heterogeneous, and therefore data were not pooled. The review found that regular and prolonged use of vaginal moisturizers was effective in improving vaginal dryness, dyspareunia, and sexual satisfaction. Educational and counseling interventions targeting sexual dysfunction showed consistent improvement in various aspects of sexual health. No consistent improvements in sexual health were observed with physical activity, transdermal testosterone or hot flash interventions. There was a lack of BCS-specific data on vaginal lubricants, vibrators, dilators, pelvic floor therapy, flibanserin or ospemifene. Overall, the quality of evidence for these studies was moderate to very low. Because each of the interventions with BCS data had limited efficacy, clinical trials to test novel interventions are needed to provide evidence-based clinical recommendations and improve sexual function in BCS.

Efficacy of the FemiScan Pelvic Floor Therapy System for the Treatment of Urinary Incontinence [380

INTRODUCTION: Urinary incontinence (UI) affects the quality of life of 15–20% of women in the United States. Pelvic floor muscle training can be effective in alleviating symptoms; however, women need instruction, motivation, and feedback to gain optimal benefit from pelvic rehabilitation. The U.S. Food and Drug Administration–approved FemiScan Pelvic Floor Therapy System uses office electromyography (EMG) and an in-home programmable device to provide training, motivation, and feedback. This study was undertaken to document the outcomes of women who completed a physician-supervised program utilizing the FemiScan Pelvic Floor Therapy System. METHODS: In this chart review, women with de novo, postpartum, or postsurgical stress, urge, or mixed UI, who completed the eight-visit protocol were included in the analysis. We collected patient demographics, EMG measurements and responses to subjective questions about the status of their UI symptoms. Paired t tests were used to analyze the data. RESULTS: Of 202 patients who started treatment with FemiScan, 160 (79%) completed the eight-visit protocol. No adverse events were reported. Mean age was 54±12 years. There was a statistically significant increase (11±16 μV, P<.001) in peak EMG measurements between the first and final visits. Seventy-eight percent considered their symptoms at least 80% improved with 46% reporting complete subjective cure. Women who completed four or more visits but less than eight also demonstrated subjective and objective improvement (data not shown). CONCLUSION: FemiScan is a safe and effective treatment for UI with concomitant increased pelvic floor EMG activity.

V2-06 SKENE'S GLAND CYST EXCISION

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-06 SKENE'S GLAND CYST EXCISION Philippe Zimmern and Gary Lemack Philippe ZimmernPhilippe Zimmern More articles by this author and Gary LemackGary Lemack More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.331AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To review our experience with the long-term outcome after Skene's gland cyst excision METHODS A surgical database of all procedures performed by two surgeons at one institution was reviewed for Skene's gland cyst excision. Data extracted from an electronic medical record or medical charts were presenting symptoms, pre-operative evaluation, site of excision, peri-operative complications, and clinical outcomes. Technique of surgical excision is presented in the attached movie, and includes cystoscopy, dissection of cyst wall from the floor of the urethra with scissors or bovie on low setting, distal urethroplasty as indicated, complete removal of the cyst wall, and primary vaginal wall closure. Urethral Foley catheter is left indwelling for 3–5 days afterwards and sexual function is resumed after completion of vaginal healing. RESULTS From 2001 to 2013, ten women were studied. Mean age was 45 (range: 29 to 66). Presenting symptoms were: dyspareunia (4), urinary tract infections (4), vaginal mass (1) and voiding dysfunction (1), with half of women having more than one presenting symptoms. Evaluation included an MRI in all women, and a voiding cystourethrogram in 5 to exclude a urethral diverticulum. Skene's gland cyst was observed on the left (5) or right (5) sides, with no cases being bilateral. No peri-operative complications were reported. All procedures were done on an outpatient basis. A distal meatoplasty was done in 2 women, and a urethral dilation in another 2. Mean follow-up was 3.5 years (range 3 to 96 months). One woman died of unrelated cause (stroke). Four women had mild stress urinary incontinence in follow-up years, one requiring pelvic floor therapy, the others simple observation. Two have been treated for occasional urinary tract infections. One underwent a distal urethroplasty 6 years later after a failed urethral dilation. Eight of ten women who were sexually active remained sexually active post-operatively. CONCLUSIONS Excision of Skene's gland cyst is a safe procedure with acceptable long-term functional outcomes. Excision of a Skene's gland cyst is: a. A frequent vaginal procedure due to the large incidence of this condition b. A bloody procedure possibly requiring blood transfusion c. A delicate operation that can lead to distal urethral wall damage and possible meatoplasty (∗) d. Similar to a urethral diverticulum removal and requiring closure of the urethral ostium e. Likely to recur even after complete excision of the gland linings © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e99 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippe Zimmern More articles by this author Gary Lemack More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pelvic Pain of Pudendal Nerve Origin: Surgical Outcomes and Learning Curve Lessons

When pudendal nerve dysfunction fails to improve after medical and pelvic floor therapy, a surgical approach may be indicated. "Traditional," "posterior," transgluteal nerve decompression fails in an unacceptably high percentage of patients. Insights into pudendal neuroanatomy and pathophysiology offer improved microsurgical outcomes. To evaluate results of a peripheral nerve approach to the pudendal nerve, 55 patients were prospectively evaluated. This cohort included 25 men and 30 women. Surgical approach was posterior, transgluteal if symptoms included rectal pain; or "anterior," inferior pubic ramus approach if symptoms excluded rectal pain. Surgical approach was "resection," if trauma created a neuroma, and "decompression," if there were no neuroma. Effect of comorbidities was analyzed. At 14.3 months postoperatively, untreated anxiety/depression correlated with outcome failure, regardless of surgical approach, p < 0.002. There was no difference in results, men versus women, "anterior" versus "posterior" approach, or neuroma resection versus neurolysis. Success correlated with the "learning curve" of the surgeon. Self-rated success was significantly better (p < 0.0001) for patients operated on during the second year of the study than the first year of the study, and improved again in the final year of the study (p < 0.04), with 86% of the patients in final year achieving an excellent result and 14% achieving a good result. There is hope for surgical relief from pudendal nerve problems by distinguishing neuroma from compression in the diagnosis, and then choosing a site-specific surgical approach related to which pudendal nerve branches are involved.

Clinical outcome after endoscopic therapy for occult vesicoureteral reflux in females: preliminary results of a retrospective case series

Objective. The aim of this study was to evaluate the clinical outcome after endoscopic therapy by injection of bulking agent in the treatment of occult vesicoureteral reflux (VUR) [no VUR on standard voiding cystourethrography (VCUG), but positive 99mTc-2,3-dimercaptosuccinic acid (DMSA) scan] in females who have recurrent febrile urinary tract infections (UTIs). Material and methods. A case series was retrospectively identified of 24 females (mean age 15.5 years) with negative VCUG, but renal scars in one (n = 4) or both (n = 20) kidneys on DMSA scan. Endoscopic injection was performed bilaterally in 20 (83.3%) and unilaterally in four patients (16.7%). The incidence of postoperative UTIs was documented with a mean follow-up of 2.5 years (range 1–6 years). Results. The mean renal part function (DMSA scan) on the left and right sides was 53.5% (15–74%) and 47.3% (26–85%), respectively. Twenty-one out of 24 patients (87.5%) showed no evidence of any febrile UTIs postoperatively. One patient (4.2%) experienced a further febrile UTI 6 months after treatment. Two other patients (8.3%) had one questionable afebrile UTI, 4 and 3 years after therapy. Pressure–flow electromyography confirmed a dysfunctional voiding pattern in 12 patients (50%) treated with pelvic floor therapy and behavioural interventions before endoscopic therapy. Conclusions. Injection of bulking agent seems to be a suitable treatment for occult VUR in females to prevent further febrile UTIs. Patients with occult VUR should undergo a careful evaluation of possible urodynamic disorders such as dysfunctional voiding. These findings should be studied in prospective trials before drawing any conclusions.

For Vaginal Prolapse, Is One Type of Surgery Any Better Than the Other?

Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known about the comparative efficacy of surgical techniques or the role of perioperative pelvic floor therapy. In the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, 374 women with vaginal prolapse and stress urinary incontinence were randomized first to perioperative behavioral therapy …

SUI-Current Medicinal Therapeutic Options

Urinary incontinence is a common and distressing condition known to adversely affect quality of life. It is widely prevalent and places a considerable financial burden on society. Stress urinary incontinence describes a symptom or a sign. A diagnosis of urodynamic stress incontinence can only be made following urodynamic investigation. This condition is defined as ‘the involuntary leakage of urine during increased abdominal pressure in the absence of a detrusor contraction. The aetiology of urodynamic stress incontinence is complex and remains poorly understood. There are several options available for the management of SUI: conservative, medical as well as surgical. The initial line of treatment in USI should be conservative, with lifestyle advice and pelvic floor muscle training. Medical management is a relatively new approach in the treatment of stress incontinence and should be considered after behavioural intervention and pelvic floor muscle training has failed and where there are no contra indications to the use of duloxetine. Surgery however remains the mainstay of treatment in women with severe stress incontinence or in those who fail to improve with conservative measures. The aim of this review is to describe the epidemiology of stress urinary incontinence and consider the various modalities for its conservative management Keywords: Conservative therapy, duloxetine, estrogen, pelvic floor therapy, pessary, radiofrequency denaturation, stress urinary incontinence, urodynamics stress incontinence.

Outcomes of a Comprehensive Nonsurgical Approach to Pelvic Floor Rehabilitation for Urinary Symptoms, Defecatory Dysfunction, and Pelvic Pain

The authors' intent was to determine the clinical efficacy of comprehensive pelvic floor rehabilitation among women with symptoms of pelvic floor dysfunction (PFD). We performed a retrospective analysis of women referred to an academic female pelvic medicine and reconstructive surgery practice for PFD. Data were gathered from the records of 778 women referred for pelvic floor therapy for urinary, bowel, pelvic pain, and sexual symptoms over the course of 4 years. Patients who completed at least 5 therapy sessions reported a mean symptom improvement of 80% in each of the 3 main categories analyzed, namely, urinary incontinence, defecatory dysfunction, and pelvic pain. Comprehensive, nonoperative management of PFD including pelvic floor muscle training, biofeedback, electrogalvanic stimulation, constipation management, behavioral modification, incontinence devices, and pharmacotherapy including vaginal estrogen is effective in the treatment of women with PFD.

Prevalence of Urinary Tract Infection and Vesicoureteral Reflux in Children with Lower Urinary Tract Dysfunction

Lower urinary tract dysfunction is a common pediatric urological problem that is often associated with urinary tract infection. We determined the prevalence of a urinary tract infection history in children with lower urinary tract dysfunction and its association, if any, with gender, bowel dysfunction, vesicoureteral reflux and specific lower urinary tract conditions. We retrospectively reviewed the charts of children diagnosed with and treated for lower urinary tract dysfunction, noting a history of urinary tract infection with or without fever, gender, bowel dysfunction and vesicoureteral reflux in association with specific lower urinary tract conditions. Of the 257 boys and 366 girls with a mean age of 9.1 years 207 (33%) had a urinary tract infection history, including 88 with at least 1 febrile infection. A total of 64 patients underwent voiding cystourethrogram/videourodynamics, which revealed reflux in 44 (69%). In 119 of the 207 patients all infections were afebrile and 18 underwent voiding cystourethrogram/videourodynamics, which revealed reflux in 5 (28%). A urinary tract infection history was noted in 53% of girls but only 5% of boys (p <0.001). Patients with detrusor underutilization disorder were statistically more likely to present with an infection history than patients with idiopathic detrusor overactivity disorder or primary bladder neck dysfunction (each p <0.01). Females with lower urinary tract dysfunction have a much higher urinary tract infection incidence than males. This association was most often noted for lower urinary tract conditions in which urinary stasis occurs, including detrusor underutilization disorder and dysfunctional voiding. Reflux was found in most girls with a history of febrile infections. Since reflux was identified in more than a quarter of girls with only afebrile infections who were evaluated for reflux, it may be reasonable to perform voiding cystourethrogram or videourodynamics in some of them to identify reflux.

Abstract ES4-1: Navigating the Obstacles and Risks of Survivorship: Breast Cancer Sexuality: Issues and Answers

Abstract The sexual consequences of breast cancer and its treatments are well known. Sexual difficulties include alteration in hormonal levels, changes in sexual organs and anatomy, vaginal and vulvar dryness, changes in libido, increased latency to orgasm and decreased intensity of orgasmic response. Changes in body image, sexual self-esteem and relationship dynamic tension may present as survivorship challenges for the breast cancer patient and her partner. Severe vulvo vaginal and clitoral atrophy as a result of chemotherapy and/or adjuvant hormone therapy, and loss of libido secondary to dyspareunia are widespread. Cytostatic medications that are prescribed for long-term use (aromatase inhibitors) can impact bone health, sexual functioning/satisfaction and overall quality of life. Many women on aromatase inhibitors have severe complaints of vulvar and vaginal atrophy. Sexual dysfunction is common for breast cancer population and limited acceptable treatments are available. Minimally absorbed local vaginal estrogen use in this population remains controversial and a hotly debated controversial topic. More data should be forthcoming. There are multiple new innovative treatments in the research pipeline for female sexual dysfunction. DHEA intravaginal suppositories, Flibanserin and Bremelanotide (PT 141) remain promising although they have not been adequately studied in the breast cancer population. Ospemifene a novel estrogen agonist/ antagonist has demonstrated a strong estrogenic effect on the vaginal epithelium during a three month trial period and did not stimulate the endometrium; however, the medication did mildly aggravate hot flashes (this did not lead to drug discontinuation). Although not studied in breast cancer patients, pivotal Phase 3 data confirmed effectiveness of ospemifene as effective treatment for vulvovaginal atrophy. In a recent article in Menopause, Ospemifene and 4-hydroxyospemifene effectively prevented and treat breast cancer in Mtag. TG Transgenic Mouse. Testosterone use remains off label and is not FDA approved, yet it is widely used in the non cancer population. New emerging safety data will be presented. Vaginal moisturizers, lubricants and dilators in association with genito pelvic floor therapy and intravaginal valium suppositories can be considered front line treatment for atrophy, dyspareunia and hypertonic vaginismus. New innovative data on non hormonal management of hot flashes is and important initial step in the overall management of the breast cancer patient who is suffering from sexual dysfunction. A multi model treatment paradigm will be presented which will include pharmacologic, nonpharmacologic, and psychosocial interventions. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr ES4-1.

A Retrospective Review of Patient Outcomes in a Multi-Disciplinary Clinic Model for Treatment of Chronic Pelvic Pain

To assess the change in Visual Analog Score (VAS) in patients with Chronic Pelvic Pain treated in a Multi-Disciplinary Chronic Pelvic Pain Clinic. This study is a retrospective chart review of patients enrolled in a Multi-Disciplinary Chronic Pelvic Pain Clinic from July 2009 to January 2012. This study took place in an outpatient clinic setting. Female patients with Chronic Pelvic Pain. The pain level was assessed both pre-treatment and post-treatment with a Visual Analog Score (VAS). Treatments in the Multi-Disciplinary Chronic Pelvic Pain Clinic include oral medications, bladder instillations, trigger point injections, pelvic floor therapy, counseling and surgery when indicated. A total of 61 patients were identified from July 2009 to January 2012. Of these, 13 were lost to follow-up and/or incomplete data was obtained. Of the remaining 48 patients, the mean pre-treatment VAS score was 6.8. After treatment in the Multi-Disciplinary Chronic Pelvic Pain Clinic, improvement was seen in 91.6% (44/48) of patients, with a mean post-treatment VAS score of 2.9. Patients were staged according to the Multi-Organ Pelvic Pain Staging criteria (MOPPS). Please see table 1 below.Table 1MOPPS: MultI-Organ Pelvic Pain StagingSTAGE 0:Duration>1 month, but<6 months and/or one organ system affectedSTAGE 1:Duration > = 6 months, but<1year and/or one organ system affectedSTAGE 2:Duration > = 1 year, but <2 years and/or two organ systems affectedSTAGE 3:Duration > = 2 years, but <5 years and/or three organ systems affectedSTAGE 4:Duration > = 5 years and/or four or more organ systems affected Open table in a new tab Of the 48 patients, twenty-four were MOPPS Stage IV (50%); twelve patients were MOPPS Stage III (25%); eleven patients were MOPPS Stage II (22.9%); one patient was MOPPS Stage I (2.9%). Please see table 2 below for mean VAS score by MOPPS Stage.Table 2Mean VAS Pre/Post Treatment by StageMOPPS StagePre-treatmentPost-treatmentStage I2.01.0Stage II6.12.2Stage III6.22.2Stage IV7.63.7 Open table in a new tab The average length of enrollment in the Multi-Disciplinary Chronic Pelvic Pain Clinic was 6 months. Treatment in a Multi-Disciplinary Chronic Pelvic Pain Clinic results in improvement in patient pain level as measured by a Visual Analog Score.

PEDIATRIC UROLOGY High efficacy of biofeedback therapy for treatment of dysfunctional voiding in children

IntroductionDysfunctional voiding is a frequent condition in children associated with symptoms of incontinence. The aim of this study was to present the efficacy of biofeedback treatment on the resolution of clinical symptoms in a large cohort of children with urodynamically confirmed dysfunctional voiding.Material and methods81 children (75 girls and 6 boys) aged 6-18 years (mean: 10.32 ±3.17 yrs.) with a dysfunctional voiding pattern are presented. 74/81 (92.6%) of children were unresponsive to standard urotherapy and prior pharmacotherapy. Symptoms of bladder dysfunction were evaluated by questionnaire, bladder diary and an urodynamic study according to definitions and standards set by ICCS. The biofeedback training was planned for 2 months. Each session consisted of about 30 repeats of 5 s contraction and 30 s relaxation of pelvic floor muscles and external urethral sphincter. Biofeedback was performed together with standard urotherapy.Results67 (82.72%) of the 81 children declared wetting during the day and 41 (50, 62%) – wetting during the night. 32/81 (39.5%) children had increased voiding frequency and 43 (53.08%) had decreased bladder capacity. Following 2 months of biofeedback therapy daytime incontinence resolved in 34/67 (50.7%) children and nighttime incontinence in 22/41 (53.65%). A further 40,3% declared partial improvement in daytime and 26.7% in nighttime wetting.ConclusionsBiofeedback treatment is an effective therapeutic option for children with dysfunctional voiding. Pelvic floor therapy with biofeedback should be offered to children with dysfunctional voiding resistant to standard urotherapy.

Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis

The objectives of this study are to investigate myofascial pain in patients with interstitial cystitis (IC) and to correlate myofascial exam findings with validated questionnaires. A retrospective chart review was performed on 186 patients with a diagnosis of IC from April 2007 to December 2008. Demographics, history and physical examination, and validated pelvic floor dysfunction questionnaire scores were extracted. The data was evaluated with SPSS for Windows using Spearman's rho, Mann-Whitney, and Kruskal-Wallis statistical analyses. Myofascial pain was demonstrated in 78.3% of IC patients with at least one myofascial trigger point, and 67.9% of patients had numerous areas of trigger points. Mild correlations were seen with trigger points and scores from the PUF, PFDI-20, and PFIQ-7 questionnaires. Myofascial pain is prevalent among IC patients and positively correlated with pelvic floor dysfunction scores. These findings support evaluation of pelvic floor myofascial pain in IC patients and suggest a possible benefit from pelvic floor therapy.

Failed ITB Syndrome Rehab in a Female Runner with Hip Pain

HISTORY: A 37 year old female with past medical history significant for uterine fibroids presented with persistent left hip pain. She described her left hip pain as an achy, heavy sensation brought on only with running or prolonged sitting. She was initially seen by her PCP and initial hip xray report was read as negative. The patient discontinued running for 10 months and during that time, was pain free. However resumed running, her hip pain returned. The patient then went to a sports medicine physician who referred her for physical therapy. The patient also had repeat hip/pelvis xrays which showed large calcified fibroid. The patient underwent months of physical therapy focusing on iliotibial band stretching but had little improvement in her left hip pain. The referral was then made to a musculoskeletal physiatrist specializing in pelvic floor dysfunction. PHYSICAL EXAMINATION: Examination revealed normal gait, lumbar spine and hip ROM. Gillet test, Faber's test and Scour tests were negative. Slump sit was negative. Ober's test was positive. Ely's test was positive. Left greater trochanter was non-tender to palpation. Mild pain with palaption of left psoas and iliacus muscles on left. Pelvic exam: Palpation of the left pelvic floor was tender with taut bands found in the left levator ani. Palpation of the left obturator internus muscle reproduced the patient's left hip pain. The patient had difficulty relaxing her left pelvic floor. DIFFERENTIAL DIAGNOSIS: Iliotibial band bursitis Femoral neck stress fracture Pelvic stress fracture Hyperonic pelvic foor dysfunction Gluteus medius strain TEST AND RESULTS: The patients most recent hip/pelvis xrays were reviewed which showed large calcified fibroid. No other abnormalities were seen in the hips or pelvis. FINAL WORKING DIAGNOSIS: Pelvic floor dysfunction secondary to fibroids causing referred pain to left hip TREATMENT AND OUTCOMES: Pelvic floor physical therapy for hypertonic pelvic floor with attention to releasing taut bands in her left levator ani muscle. The patient completed 4 wks of physical therapy and was instructed to slowly build up her previous running distance and speed. On follow up visit the patient reported diminished left hip pain with running as well as with prolonged sitting. Plan for future myomectomy prn

The Role of Uroflowmetry Biofeedback and Biofeedback Training of the Pelvic Floor Muscles in the Treatment of Recurrent Urinary Tract Infections in Women With Dysfunctional Voiding: A Randomized Controlled Prospective Study

To evaluate the efficacy of a training program with uroflowmetry biofeedback and pelvic floor relaxation biofeedback on urodynamic and voiding parameters in women with dysfunctional voiding. Eighty-six women with recurrent urinary tract infections (UTIs) and dysfunctional voiding were randomly assigned to receive a treatment schedule as follows: uroflowmetry biofeedback (group 1), biofeedback training of the pelvic floor muscles (group 2), uroflowmetry biofeedback combined to biofeedback training of the pelvic floor muscles (group 3), no treatment (group 4). Patients were regularly evaluated by American Urological Association Symptom Index and urodynamics during the study period. All the patients were followed up for 1 year with monthly urine cultures. A further evaluation was done at month 24 by American Urological Association Symptom Index and free uroflowmetry with measurement of residual urine. The prevalence of storage and emptying symptoms decreased significantly at 3, 6, and 12 months in the groups 1, 2, and 3, and remained stable during the study period. Mean flow rate, flow time, voiding volume increased significantly, whereas postvoid residual urine decreased. The prevalence of UTI decreased significantly in groups 1, 2, and 3. At month 24, storage and emptying symptoms and voiding patterns were similar to the baseline values in all the patients. The incidence of UTIs was similar to baseline values in groups 1, 2, and 3. Training the voluntary control of the pelvic floor seems essential in obtaining control over the bladder function. These results reinforce the importance of pelvic floor therapy in the resolution of UTIs.

A double-blind randomized controlled trial of electromagnetic stimulation of the pelvic floor vs sham therapy in the treatment of women with stress urinary incontinence

A double-blind randomized controlled trial of electromagnetic stimulation of the pelvic floor vs sham therapy in the treatment of women with stress urinary incontinence

UP-1.180: Effect of Extracorporeal Magnetic Innervation Pelvic Floor Therapy (ExMI) for Urinary Incontinence after Radical Prostatectomy

UP-1.180: Effect of Extracorporeal Magnetic Innervation Pelvic Floor Therapy (ExMI) for Urinary Incontinence after Radical Prostatectomy

Percutaneous tibial nerve stimulation (PTNS): A literature-based assessment

An estimated 34 million adults in the United States have an overactive bladder, which has a significant impact on health and quality of life and significant overall financial impact on the health care delivery system. Current treatment alternatives include behavioral modifications, pelvic floor therapy, medications, sacral nerve stimulation, intravesical injection, and surgery. A recent addition to the urologist’s armamentarium of care is percutaneous tibial nerve stimulation. This article reviews a variety of sources that present current thinking about percutaneous tibial nerve stimulation, its clinical use, and its place in the continuum of care.

Two popular treatment options for neurogenic bladder

There are several etiologies for a neurogenic bladder, including congenital and acquired. The neurogenic bladder can lead to urinary tract infections, urinary incontinence and other secondary issues. Treatment options, such as clean intermittent catheterization, have been important in the care of these patients. Two treatment options for neurogenic bladder have gained popularity and have increased exposure in the literature over the past decade – botulinum toxin and antibiotic prophylaxis. Current treatment options for detrusor overactivity, urinary urgency and urge incontinence include pelvic floor therapy, anticholinergics and neuro modulation via InterStim (sacral nerve stimulation) or tibial nerve stimulation. Augmentation cystoplasty is not as common due to the other less-invasive treatment options. Botulinum-A toxin offers another minimally invasive treatment option [1,2]. However, treatment with botulinum-A toxin does have unanswered questions:

Effect of Extracorporeal Magnetic Innervation (ExMI) Pelvic Floor Therapy on Urinary Incontinence after Radical Prostatectomy

Purpose: To evaluate the safety and clinical effects of extracorporeal magnetic innervation (ExMI) for urinary incontinence after radical prostatectomy. Materials and Methods: Thirty-two patients with urinary incontinence after radical prostatectomy were randomly assigned to receive either ExMI treatment or pelvic floor training alone. For the ExMI group, treatment was initiated 1 week after catheter removal and the treatment sessions were for 20 minutes, twice a week, for 8 weeks. For the control group, only pelvic floor muscle exercises were performed. Patients were followed up at 1 week and 1, 2, 3, and 6 months. Outcomes were assessed by 24-hour pad weight testing, the number of pads used daily, and a quality-of-life survey (I-QoL). Results: Leakage weight during the 24 hours after removing the catheter was 655g and 646g for the ExMI and control groups, respectively. At 1 month, it was 147g and 187g; at 2 months, 33g and 81g (p=0.001); and at 3 months, 9g and 45g (p=0.001), respectively. Finally, 6 months later, leakage weight was less than 10g in both groups. The number of pads used daily after removing the catheter was 4.2 and 4.1 for the ExMI and control groups, respectively. At 1 month, it was 1.5 and 1.8; at 2 months, 0.6 and 0.9 (p=0.033); and at 3 months, 0.1 and 0.6 (p=0.002), respectively. Finally, 6 month later, pads counts were 0 and 0.1. I-QoL scores decreased after surgery, but gradually improved in both groups. No other side effects or adverse events were observed. Conclusions: ExMI provided earlier recovery of continence than in the control group after radical prostatectomy.