Electrical stimulation for urinary incontinence in women: a systematic review.
BACKGROUND
Electrical stimulation is commonly recommended to treat urinary incontinence in women. It includes several techniques that can be used to improve stress, urge, and mixed symptoms. However, the magnitude of the alleged benefits is not completely established.


OBJECTIVE
To determine the effects of electrical stimulation in women with symptoms or urodynamic diagnoses of stress, urge, and mixed incontinence.


METHODS
Our review included articles published between January 1980 and January 2012. We used the search terms ″urinary incontinence″, ″electrical stimulation ″, ″ intravaginal ″, ″ tibial nerve ″ and ″ neuromodulation ″ for studies including female patients.


METHODS
We evaluated randomized trials that included electrical stimulation in at least one arm of the trial, to treat women with urinary incontinence.


METHODS
Two reviewers independently assessed the data from the trials, for inclusion or exclusion, and methodological analysis.


RESULTS
A total of 30 randomized clinical trials were included. Most of the trials involved intravaginal electrical stimulation. Intravaginal electrical stimulation showed effectiveness in treating urge urinary incontinence, but reported contradictory data regarding stress and mixed incontinence. Tibial-nerve stimulation showed promising results in randomized trials with a short follow-up period. Sacral-nerve stimulation yielded interesting results in refractory patients.


CONCLUSIONS
Tibial-nerve and intravaginal stimulation have shown effectiveness in treating urge urinary incontinence. Sacral-nerve stimulation provided benefits in refractory cases. Presently available data provide no support for the use of intravaginal electrical stimulation to treat stress urinary incontinence in women. Further randomized trials are necessary to determine the magnitude of benefits, with long-term follow-up, and the effectiveness of other electrical-stimulation therapies.
Gynecology Department, Pontificia Universidade Catolica do Rio Grande do Sul, RS, Brazil.
Lucas
L
Schreiner
Thais Guimarães dos
TG
Santos
Alessandra Borba Anton de
AB
Souza
Christiana Campani
CC
Nygaard
Irenio Gomes da
IG
Silva Filho
D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013979:Tibial Nerve / Q000503:physiopathology; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000628:therapy*; D014563:Urodynamics