title: [Effect the adding of biofeedback to the training of the pelvic floor muscles to treatment of stress urinary incontinence].
abstract: OBJECTIVE
  To investigate the effect of adding biofeedback (BF) to the training of pelvic floor muscles (PFMT) for the treatment of stress urinary incontinence (SUI).
  
  
  METHODS
  A prospective pilot study, randomized and controlled with women with SUI without sphincter deficiency, detected by urodynamic study and who performed the correct PFM contraction. Women with neuromuscular disorders and grade III and IV genital prolapse were excluded. Forty women were randomized into a CONTROL GROUP and BF Group. The PFMT protocol with BF equipment consisted of three sets of ten slow contractions (tonic), with a holding time of six to eight seconds at each contraction followed by a rest period of equal duration. After each sustained contraction, they performed three to four fast contractions (phasic) in the supine and standing position twice a week, for a total of 12 sessions. We evaluated the effect of adding BF to PFMT on quality of life using King's Health Questionnaire (KHQ) regarding urinary symptoms based on a voiding diary and regarding the function of pelvic floor muscles by digital palpation. The evaluation was performed initially and after 12 treatment sessions. Data are reported as mean and standard deviation. The Mann-Whitney test was used for the analysis of homogeneity and to determine differences between groups, and the Wilcoxon test was used to determine possible differences between the times of observation, with the level of significance set at 0.05.
  
  
  RESULTS
  A significant decrease in the scores of the domains assessed by the KHQ was observed in the comparison between groups, except for the general health domain (BF Group: 32.8 ± 26.9 versus
  
  
  METHODS
  48.4 ± 29.5, p<0.13). Accordingly, there was improvement in PFM function after treatment in the BF Group, regarding power (4.3 ± 0.8, p= 0.001), endurance (6.0 ± 2.2, p<0.001) and fast (9.3 ± 1.9, p=0.001). When comparing the groups, the BF Group showed a positive result regarding power (BF Group 4.3 ± 0.8 versus CONTROL GROUP 2.5 ± 0.9, p<0.001), endurance (6.0 ± 2.2 BF Group versus CONTROL GROUP 2.7 ± 1.9, p<0.001) and fast (BF Group 9.3 ± 1.9 versus CONTROL GROUP 4.6 ± 3.2, p<0.001). Reduction of nocturnal urinary frequency (1.2 ± 1.2 versus 0.7 ± 0.9, p=0.02) and of effort urine loss (1.5 ± 1.4 versus 0.6 ± 0.8, p=0.001) was observed in the BF Group.
  
  
  CONCLUSIONS
  The addition of BF to the PFMT for the treatment of SUI, applied according to the protocol described, improved PFM function, reduced urinary symptoms, and improved of the quality of life.
authors.affiliation: Departamento de Ginecologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil.
authors.forename: Fátima Faní
authors.initials: FF
authors.lastname: Fitz
authors.forename: Ana Paula Magalhães
authors.initials: AP
authors.lastname: Resende
authors.forename: Liliana
authors.initials: L
authors.lastname: Stüpp
authors.forename: Thaís Fonseca
authors.initials: TF
authors.lastname: Costa
authors.forename: Marair Gracio Ferreira
authors.initials: MG
authors.lastname: Sartori
authors.forename: Manoel João Batista Castello
authors.initials: MJ
authors.lastname: Girão
authors.forename: Rodrigo Aquino
authors.initials: RA
authors.lastname: Castro
mesh_terms: D001676:Biofeedback, Psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor; D010865:Pilot Projects; D011446:Prospective Studies; D014550:Urinary Incontinence, Stress / Q000628:therapy*