title: Vaginal cone use in passive and active phases in patients with stress urinary incontinence.
abstract: OBJECTIVE
  To evaluate vaginal cone therapy in two phases, passive and active, in women with stress urinary incontinence.
  
  
  METHODS
  A prospective study was conducted at the Department of Obstetrics and Gynecology, São Paulo University, Brazil. Twenty-four women with a clinical and urodynamic diagnosis of stress urinary incontinence were treated with vaginal cones in a passive phase (without voluntary contractions of the pelvic floor) and an active phase (with voluntary contractions), each of which lasted three months. Clinical complaints, a functional evaluation of the pelvic floor, a pad test, and bladder neck mobility were analyzed before and after each phase.
  
  
  RESULTS
  Twenty-one patients completed the treatment. The reduction in absolute risk with the pad test was 0.38 (p<0.034) at the end of the passive phase and 0.67 (p<0.0001) at the end of the active phase. The reduction in absolute risk with the pelvic floor evaluation was 0.62 (p<0.0001) at the end of the passive phase and 0.77 (p<0.0001) at the end of the active phase. The reduction in absolute risk of bladder neck mobility was 0.38 (p<0.0089) at the end of the passive phase and 0.52 (p<0.0005) at the end of the active phase. Complete reversal of symptomatology was observed in 12 (57.1%) patients, and satisfaction was expressed by 19 (90.4%).
  
  
  CONCLUSIONS
  Using vaginal cones in the passive phase, as other researchers did, was effective. Inclusion of the active phase led to additional improvement in all of the study parameters evaluated in women with stress urinary incontinence. Randomized studies are needed, however, to confirm these results.
authors.affiliation: Divisão de Clínica Ginecológica, Ginecologia Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. jorge_milhem@uol.com.br
authors.forename: Jorge Milhem
authors.initials: JM
authors.lastname: Haddad
authors.forename: Ricardo Muniz
authors.initials: RM
authors.lastname: Ribeiro
authors.forename: Wanderley Marques
authors.initials: WM
authors.lastname: Bernardo
authors.forename: Maurício Simões
authors.initials: MS
authors.lastname: Abrão
authors.forename: Edmund Chada
authors.initials: EC
authors.lastname: Baracat
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D009119:Muscle Contraction / Q000502:physiology*; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000503:physiopathology*; D010570:Pessaries; D011446:Prospective Studies; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000628:therapy*