Intravaginal maximal electrical stimulation in the treatment of urinary incontinence.
Urinary incontinence imposes a large economic burden, estimated at $10 billion per year. As the cost of health care continues to rise, conservative therapeutic measures are becoming more attractive. Anecdotal reports suggest that electrical stimulation may be up to 87% effective in the treatment of urinary incontinence. Investigators use different stimulation devices and protocols and make a comparison of results difficult. The true efficacy of electrical stimulation for the treatment of urinary incontinence is unknown since there have been no controlled clinical trials. Within our referral-based urogynecology practice, we employ intermittent, intravaginal maximal electrical stimulation in conjunction with bladder drills and pelvic floor exercises. Over a one-year period we treated 76 women with urinary incontinence: 19 with stress incontinence (SUI), 30 with detrusor instability (DI) and 27 with mixed incontinence (MI). After six weeks, our overall objective improvement rate was 76%; 89% of patients with SUI, 73% with DI and 70% with MI met the criteria for improvement. Long-term follow-up averaged 6 months, with a range of 2-12. Of patients who showed an initial objective improvement, 87% maintained that improvement. Intravaginal electrical stimulation may be effective therapy for urinary incontinence. Controlled clinical trials are needed to determine its efficacy and standardize stimulation protocols before its widespread use.
Caputo
R M
RM
Department of Obstetrics and Gynecology, Methodist Hospital of Indiana, Inc., Indianapolis 46202.
Benson
J T
JT
McClellan
E
E
D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D010298:Parity; D012008:Recurrence; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000145:classification / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics; D014621:Vagina