Effect of Electrical Stimulation on Stress and Urge Urinary Incontinence

A systematic review 1 including 9 RCTs was abstracted in DARE. Only one study evaluated the effect of electrical stimulation on urge incontinence (n=371). Two studies demonstrated improved self-reported outcomes, whereas four did not. Four studies measuring leakage by pad testing before and after treatment: all found significant improvement after electrical stimulation. Side effects were reported in around half of the women in either group.

In a double-blind study 2 40 women with urge incontinence as predominant symptom were randomly assigned to intravaginal electric stimulation (ES; three 20-min sessions per week over a 7-week period using a Dualpex Uro 996 at 4 Hz) or sham stimulation, with follow-up at 1 month. The number of micturitions per 24 h after treatment was reduced and pelvic floor muscle strength was improved in both groups. Urge incontinence was reduced non-signifantly to 15% in ES group vs 31.5% in sham group post-treatment.

In another 3 trial 35 postmenopausal women were treated with ES or Kegel exercises (KE). No significant improvement in objective outcome variables was observed with ES compared to KE. Neither was subjective improvement significant.

In a third RCT 4 36 patients were randomised to ES or sham ES. The treatment group had an increase in maximum bladder capacity (P < 0.02), a reduction in the total number of voids (over 24 h; P < 0.02), in the number of episodes of voiding urgency (P < 0.001) and, in the number of episodes of urinary incontinence (P < 0.001).

In a fourth trial 5 200 women with stress incontinence as predominant pattern were randomised to behavioral training, behavioral training plus home ES or self-administered behavioral treatment using a self-help booklet (control condition) for 8 weeks. Intention-to-treat analysis showed that incontinence was reduced a mean of 68.6% with behavioral training, 71.9% with behavioral training plus ES, and 52.5% with the self-help booklet (P =.005). Behavioral training and behavioral training plus ES were significantly more effective than self-help, but they were not significantly different from each other.

Comment: The quality of evidence is downgraded by inconsistency of results and by imprecise results (limited study size for each comparison).

References

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