Efficacy of intravaginal electrical stimulation added to bladder training in women with idiopathic overactive bladder: A prospective randomized controlled trial

Yildiz, Necmettin; Alkan, Hakan; Sarsan, Ayse

doi:10.1590/S1677-5538.IBJU.2021.0161

Acessibilidade / Reportar erro

Brasil

International braz j urol

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • IBJUInt. braz j urol 47 (6) • Nov-Dec 2021 • https://doi.org/10.1590/S1677-5538.IBJU.2021.0161 copy

Efficacy of intravaginal electrical stimulation added to bladder training in women with idiopathic overactive bladder: A prospective randomized controlled trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To evaluate the efficacy of intravaginal electrical stimulation (IVES) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with idiopathic overactive bladder (OAB).

Materials and Methods:

Sixty-two women with idiopathic OAB were randomized into two groups using the random numbers generator as follows: Group 1 received BT alone (n:31), and Group 2 received BT+IVES (n:31). IVES was performed for twenty minutes three days a week over a course of eight weeks for a total of 24 sessions. Patients were evaluated in terms of incontinence severity (24-hour pad test), pelvic floor muscles strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes and number of pads), symptom severity (OAB-V8), incontinence-related QoL (IIQ-7), treatment success (positive response rate), cure/improvement rate and treatment satisfaction (Likert scale).

Results:

A statistically significant improvement was found in all parameters for all groups at the end of the treatment compared to the baseline values except pelvic floor muscles strength in Group 1 (p <0.05). At the end of treatment, incontinence severity, frequency of voiding, nocturia, incontinence episodes, number of pads, symptom severity, and QoL were significantly improved in Group 2 compared to Group 1 (p <0.05). Treatment satisfaction, cure/improvement, and positive response rates were significantly higher in group 2 compared to Group 1 (p <0.05).

Conclusion:

We conclude that BT+IVES were more effective than BT alone on both incontinence-related QoL and clinical parameters in women with idiopathic OAB.

Keywords:
Urinary Bladder, Overactive; Electric Stimulation Therapy; Controlled Clinical Trial [Publication Type]

		Group 1 n=29	Group 2 n=29	P1	P2
Age (year) (mean±SD)		56.44±11.62	55.24±10.57	0.779
Height (cm) (mean±SD)		160.79±4.34	159.20±6.01	0.407
Weight (kg) (mean±SD)		73.68±9.11	75.20±11.92	0.409
BMI (kg/m²) (mean±SD)		28.19±3.93	29.74±4.82	0.080
Duration of incontinence (month) (mean±SD)		84.00±61.16	79.86±66.60	0.685
Education, n(%)
	Primary	12(41.4)	22(75.9)
	High school	8(27.6)	4(13.8)
	>High school	9(31.0)	3(10.3)		0.064
Smoking, n(%)
	No	24 (82.8)	26(89.7)
	Yes	5(17.2)	3(10.3)		0.191
Cup of tea/day, n(%)
	1-2 cup	12(41.4)	9(31.0)
	≥3 cup	17(58.6)	20(69.0)		0.412
Cup of coffee/day, n(%)
	No	12(41.4)	14(48.3)
	1-2 cup	15(51.7)	14(48.3)
	≥3 cup	2(6.9)	1(3.4)		0.768
Alcohol intake, n(%)
	No	29(100)	28(96.6)
	Yes	0(0)	1(3.4)		0.374
Delivery, n(%)
	No	0(0)	1(3.4)
	1-3	27(93.1)	20(69.0)
	≥4	2(6.9)	8(27.6)		0.060
Delivery type, n(%)
	No	0(0)	1(3.4)
	NSVD	22(75.9)	26(89.7)
	Sectio	7(24.1)	2(6.9)		0.097
Episiotomy, n(%)
	No	16(55.2)	18(62.1)
	Yes	13(44.8)	11(37.9)		0.594
Menopausal status, n(%)
	Premenopause	13(44.8)	10(34.5)
	Postmenopause	16(55.2)	19(65.5)		0.421
HRT use, n(%)
	No	26(89.7)	28(96.6)
	Yes	3(10.3)	1(3.4)		0.300

		Group 1 n=29	Group 2 n=29	Mann-Whitney-U test
Severity of incontinence - 24-h Pad test (gr), (mean±SD)
Pretreatment		42.06±22.15	41.48±26.25	0.779
8^th week		26.65±20.69 ^* * P<0.05: Wilcoxon test comparison with baseline values	7.05±11.97 ^* * P<0.05: Wilcoxon test comparison with baseline values	0.001
PFM strength - Perineometer (cmH2O), mean±SD
	Pretreatment	23.96±9.75	23.55±11.69	0.888
	8^th week	24.48±9.62	28.13±13.33 ^* * P<0.05: Wilcoxon test comparison with baseline values	0.308
Bladder diary
a. Frequency, mean±SD
	Pretreatment	10.44±2.75	11.75±3.69	0.082
	8^th week	8.79±2.27 ^* * P<0.05: Wilcoxon test comparison with baseline values	6.51±1.95 ^* * P<0.05: Wilcoxon test comparison with baseline values	<0.001
b. Nocturia, mean±SD
	Pretreatment	2.77±0.62	2.55±2.09	0.542
	8^th week	1.86±0.58 ^* * P<0.05: Wilcoxon test comparison with baseline values	0.89±0.90 ^* * P<0.05: Wilcoxon test comparison with baseline values	<0.001
c. Incontinence episodes, mean±SD
	Pretreatment	4.00±1.82	3.82±2.76	0.178
	8^th week	2.68±1.83 ^* * P<0.05: Wilcoxon test comparison with baseline values	0.68±1.10 ^* * P<0.05: Wilcoxon test comparison with baseline values	<0.001
d. Number of pads, mean±SD
	Pretreatment	3.55±2.38	3.31±2.17	0.602
	8^th week	2.51±1.80 ^* * P<0.05: Wilcoxon test comparison with baseline values	1.58±1.63 ^* * P<0.05: Wilcoxon test comparison with baseline values	0.017
Symptom severity - OAB-V8, mean±SD
	Pretreatment	25.37±6.48	25.93±5.28	0.749
	8^th week	14.44±5.05 ^* * P<0.05: Wilcoxon test comparison with baseline values	8.89±5.56 ^* * P<0.05: Wilcoxon test comparison with baseline values	<0.001
Quality of life - IIQ7, mean±SD
	Pretreatment	12.79±6.76	13.72±5.84	0.714
	8^th week	11.17±6.68 ^* * P<0.05: Wilcoxon test comparison with baseline values	6.27±6.19 ^* * P<0.05: Wilcoxon test comparison with baseline values	0.003
Treatment satisfaction (¹1. de Tayrac R, Haylen BT, Deffieux X, Hermieu JF, Wagner L, Amarenco G, et al. Traduction française de la terminologie commune International Urogynecological Association (IUGA)/International Continence Society (ICS) sur les troubles de la statique pelvienne chez la femme initialement publiée dans Int Urogynecol J 2010; 21:5-26 [French translation of “An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction” published in Int Urogynecol J 2010; 21:5-26. Prog Urol. 2016; 26:197-225. 2. Burkhard FC, Bosch JLHR, Cruz F, Lemack GE, Nambiar AK, Thiruchelvam N, et al. The European Association of Urology (EAU) Guidelines. EAU Guidelines on urinary incontinence in adults. In: EAU Guidelines, 2019 [Internet]. Available at. <http://uroweb.org/guideline/urinary-incontinence/> http://uroweb.org/guideline/urinary-inco... 3. Gormley EA, Lightner DJ, Faraday M, Vasavada SP; American Urological Association; Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015; 193:1572-80. 4. Subak LL, Quesenberry CP, Posner SF, Cattolica E, Soghikian K. The effect of behavioral therapy on urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2002; 100:72-8.-⁵5. Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002; 288:2293-9.), mean±SD
	8^th week	2.97±0.38	4.41±0.73	<0.001

		Group 1 n:29	Group 2 n:29	P
Treatment Success (Positive Response Rate), n (%)
	Yes	12 (41.4)	25 (86.2)	<0.001
	No	17 (58.6)	4 (13.8)
Improvement Rate, n (%)
	Improvement	14 (48.3)	26 (89.7)
	No change	15 (51.7)	3 (10.3)	0.001
Cure / Improvement Rate, n (%)
	Cure	6 (20.7)	13 (44.8)
	Improvement	8 (27.6)	13 (44.8)
	No change	15 (51.7)	3 (10.3)	0.003

Sociedade Brasileira de Urologia Rua Bambina, 153, 22251-050 Rio de Janeiro RJ Brazil, Tel. +55 21 2539-6787, Fax: +55 21 2246-4088 - Rio de Janeiro - RJ - Brazil
E-mail: brazjurol@brazjurol.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence address: Necmettin Yildiz, MD, Pamukkale Üniversitesi Tip Fakültesi, Fiziksel Tip ve Rehabilitasyon Anabilim Dali, 20100, Kinikli, Denizli, Turkey. Tel.: +90 258 2964996. E-mail: necmi74tr@hotmail.com