Maximal functional electrical stimulation as a single treatment: is it cost-effective?
OBJECTIVE
The ideal electrical parameters for maximal functional electrical stimulation (MFES) in the treatment of an overactive bladder have not yet been well established. It has been speculated that unsatisfactory results may be due to a low stimulation intensity and that the number of sessions may also be an outcome-determining factor. Herein, we present the results obtained in a group of consecutively treated patients who were given 10 sessions of MFES at the highest tolerable amplitude.


METHODS
A total of 60 patients (29 females, 31 males) with an overactive bladder were treated. All subjects underwent a urodynamic assessment and completed a 48-h micturition chart prior to treatment, immediately after the last session and 3 months after termination of treatment. The patients were thoroughly informed that the result of the treatment depended on the amplitude that they could endure; there was a gradual increase in amplitude to the maximum level that did not cause painful discomfort.


RESULTS
Immediately after termination of the stimulation, almost half of the subjects reported an improvement in their condition. However, few subjects experienced sustained symptom amelioration 3 months post-stimulation. Decreases in micturition frequency and the number of leakage episodes were noted immediately after cessation of treatment but these decreases were no longer significant 3 months post-treatment.


CONCLUSIONS
In this series, although MFES was effective in the short term, the long-term treatment outcome was unsatisfactory. A critical review suggests that outcome success is proportional to the patient's ability and willingness to accept quite a high stimulation intensity or, alternatively, follow-up home treatment. Hence, the implementation of strict primary as well as secondary selection criteria can hopefully identify patients most suitable for MFES. Another lesson to be learnt is that the identification of crucial prerequisites of successful treatment is mandatory before embarking on controlled studies.
Fehrling
Marianne
M
Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.
Fall
Magnus
M
Peeker
Ralph
R
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053201:Urinary Bladder, Overactive / Q000628:therapy*