Long-term follow-up results of pelvic floor rehabilitation in female stress urinary incontinence

The purpose of this study was to classify and characterize responders and non-responders to pelvic floor muscle (PFM) exercise in treatment of female stress urinary incontinence (SUI). Fifty-two women with SUI, mean age 45.9 years (24-a), participated in a randomized P N exercise trial for 6 months. Treatment was either intensive exercises (IE) or moderate exercises canied out at home (HE).Each of five parameters used to measure improvement of SUI (pad test, conversion of a closure pressure [cough] from negative to positive, the patient's own assessment, leakage index, and social activity index) was given one point if present. Responders to treatment were defined by cumulative score 4 and 5, borderline responders by 2 and 3, and nonresponders by 0 and 1. Classified as responders were 65% in the IE group and 20.6% in the HE group. There were no non-responders but 35% borderline responders in the IE group.The responders in the IE group were significantly older, had a longer history of SUI, a higher body mass index (BMI), stronger PFM, more severe SUI measured by leakage and social activity index before treatment, negative closure pressure, lower resting maximum urethral pressure (MUP), and in addition were more motivated for treatment than borderline responders.The discriminant function classified the responders to treatment by a combination of four initially observed variables: maximum flow rate, PFM strength, duration of SUI symptoms, and score on the leakage index. A11 patients classified as responders by use of the cumulative score in the HE group were correctly classified by the discriminant fUnCtiOn. 0 1992 Wiley-Liss. IncAbbreviations: BMI, body mass index; FUPL, functional urethral profile length; HE, home exercises; IE, intensive exercise; MUP, maximum urethral pressure; PFM, pelvic floor muscle; SUCM, simultaneous urethrocystometry; SUI, stress urinary incontinence; VAS, visual analogue scale.

Section: L a S S I F I E D A S C L A S S I F I E D A S B O R D E R supporting

confidence: 82%

Section: L a S S I F I E D A S C L A S S I F I E D A S B O R D E R supporting

confidence: 64%

Section: L a S S I F I E D A S C L A S S I F I E D A S B O R D E R mentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: Classification and characterization of responders

Bø

Larsen²

1992

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises

Bø

Hagen

Kvarstein

et al. 1990

313

138

Fifty-two women. mean age 45.9 years (24-64) with clinically and urodynamically proven stress urinary incontinence (SUI) were randomly assigned to one of two different pelvic floor muscle (PFM) exercise groups. Both groups performed 8-12 maximal PFM contractions 3 times a day for 6 months. In addition one group exercised with an instructor intensively 45 min once a week performing long-lasting contractions with the supplement of 3-4 fast contractions at the end of each long-lasting contraction.Initially and after 6 months an examination was performed comprising history, urinary leakage index, pad test, maximum urethral closure pressure, functional urcthral profile length, and recording of vaginal pressure during PFM contractions. The latter was performed monthly.After the treatment 60% of the intensive exercise (IE) group and 17.3% of the home exercisc (HE) group reported to be continent or almost contincnt (P < .01). Only the IE group demonstrated significant reduction in urinc loss: from mean 27 g to 7.1 g (P < . O l ) and iniprovemcnt in maximum resting urcthral closure prcssure (mean improvement 4.6 cin H,O, P = .02). PFM strength improved with mean 15.5 cm H,O (P < .01) in the 1E group while the HE group improved with 7.4 cm H,O (P < .01).It is concluded that the results of PFM exercise for female SUI is highly dependent upon the degrce and duration of treatmcnt and frequent supervision by thc therapist.Abbreviations used: CI = confidence intervals; FPL = functional profile length; MUCP = maximum urethral closure pressure; PFM = pelvic floor muscles; SUI = stress urinary incontinence.

One month maximal electrostimulation for genuine stress incontinence in women

Schiøotz¹

1994

While awaiting surgery for genuine urinary stress incontinence, 51 women with were treated at home for 1 month with vaginal maximal electrostimulation. They were evaluated subjectively, urodynamically, and with two different pad tests. Six patients (12%) were cured and 17 (33%) were much improved, subjectively and objectively. Statistically significant improvement was observed for both pad tests. Successful treatment was significantly more likely in women with milder degrees of incontinence but was unrelated to age or urethral pressure. Patient acceptance was excellent and apart from some vaginal soreness no complications were seen. Sixteen patients (31%) elected not to be operated on. These 16 patients were reevaluated after 1 year and 13 (81%) had maintained their improvement. Three had disimproved but were still better than before treatment; 2 again refused surgery and 1 opted for surgery. Therefore, 15 of 51 (29%) operations were saved after 1 year. This conservative treatment for stress incontinence is safe, simple, inexpensive, and reasonably successful.