title: Electrical stimulation with non-implanted electrodes for urinary incontinence in men.
abstract: BACKGROUND
  Electrical stimulation with non-implanted devices is used for patients with different types of urinary incontinence and symptoms of urgency, frequency and nocturia. The current review focused on electrical stimulation with non-implanted devices for the treatment of urinary incontinence in men.
  
  
  OBJECTIVE
  To determine the effectiveness of electrical stimulation with non-implanted devices for men with stress, urgency or mixed urinary incontinence in comparison with no treatment, placebo treatment, or any other 'single' treatment. Additionally, the effectiveness of electrical stimulation with non-implanted devices in combination with another intervention was compared with the other intervention alone. Finally, the effectiveness of one method of electrical stimulation with non-implanted devices was compared with another method.
  
  
  METHODS
  We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PreMEDLINE, and handsearching of journals and conference proceedings (searched 21 January 2012). We also searched other electronic and non-electronic bibliographic databases and the reference lists of the included studies as well as contacting researchers in the field to identify other relevant trials.
  
  
  METHODS
  Randomized and quasi-randomized controlled trials.
  
  
  METHODS
  Two review authors independently assessed all the identified trials for eligibility. Risk of bias was assessed using the Cochrane tool for determining bias. Disagreements were resolved by discussion, and a third review author was involved in the case of no consensus. Data were analysed using Cochrane methods.
  
  
  RESULTS
  Six randomized controlled trials (five full papers and one abstract) were included. There was considerable variation in the interventions used, study protocols, types of electrical stimulation parameters and devices, study populations and outcome measures. In total 544 men were included, of whom 305 received some form of electrical stimulation, and 239 a control or comparator treatment. The trials were mostly small and generally there was not sufficient information to assess risk of bias; only two trials used secure methods of randomization.There was some evidence that electrical stimulation (ES) had a short-term effect in reducing incontinence compared with sham treatment (for example risk ratio (RR) at six months 0.38, 95% CI 0.16 to 0.87) but not at 12 months. Four trials evaluated the effect of adding PFMT to ES versus pelvic floor muscle training (PFMT) alone or with biofeedback. There was no evidence of a statistically significant difference in the number of men with urinary incontinence at three months (146/239, 61% for combined treatment versus 98/156, 63% with PFMT alone; RR 0.93, 95% CI 0.82 to 1.06). However, there were more adverse effects with combined treatment (23/139, 17% versus 2/99, 2% with PFMT alone; RR 7.04, 95% CI 1.51 to 32.94) and quality of life also seemed better with PFMT alone. One small trial did not detect statistically significant differences between two methods of administration of transcutaneous electrical stimulation (anal versus perineal) but the quality of life score was lower (better) in the anal stimulation group.
  
  
  CONCLUSIONS
  There was some evidence that electrical stimulation enhanced the effect of PFMT in the short term but not after six months. There were, however, more adverse effects (pain or discomfort) with electrical stimulation.
authors.affiliation: Pelvic care CenterMaastricht, Maastricht University Medical Centre, Maastricht, Netherlands. bary.berghmans@maastrichtuniversity.nl
authors.forename: Bary
authors.initials: B
authors.lastname: Berghmans
authors.forename: Erik
authors.initials: E
authors.lastname: Hendriks
authors.forename: Arnold
authors.initials: A
authors.lastname: Bernards
authors.forename: Rob
authors.initials: R
authors.lastname: de Bie
authors.forename: Muhammad Imran
authors.initials: MI
authors.lastname: Omar
mesh_terms: D001676:Biofeedback, Psychology / Q000379:methods; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D053580:Muscle Strength; D017773:Pelvic Floor; D016032:Randomized Controlled Trials as Topic; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D014550:Urinary Incontinence, Stress / Q000628:therapy*; D053202:Urinary Incontinence, Urge / Q000628:therapy*