Vaginal cones: a conservative method of treating genuine stress incontinence

Abstract

Summary. A set of weighted vaginal cones designed to exercise the pelvic floor muscles was used by a group of 39 premenopausal patients with genuine stress incontinence who were awaiting corrective surgery. The effectiveness of the exercises in reducing urinary loss was assessed with a standard urine pad test before and after 1 month of training. Of the 30 women who completed 1 month of the exercises 70% felt they were improved or cured and 90% found it an acceptable method of treatment. Of the 30 women only 11 (37%) opted for surgery after training. There was a highly significant correlation (P<0·001, rs= ‐0·21) between decreased urine loss and increase in retained cone weight.

Conservative treatment for female stress urinary incontinence:

“…Published complication rates of MUS include 4.7% bladder perforation, 6% de novo OAB and 4% to 10% new onset urinary retention. 15 In our TFVT versus TOT study, bladder perforation was 2.9% showing that experienced surgeons can have lower complication rates (though they still occur). Surgeons using mesh should be aware of the advisories from the US Food and Drug Administration 18 and Health Canada 19 and respect the materials they are working with.…”

“…15 In our randomized comparative trial of TFVT versus TOT, at 12 months we witnessed a 77% and 81% cure rate as defined rigorously as <1 g of urine on defined pad test. 16 Others have reported similar cure rates, albeit with varying definitions of cure.…”

“…15 Side effects, such as vaginal pain and increased vaginal discharge, were reported in one study among 10% of the patients, although no treatment was required and there was no need to discontinue therapy. 16 A systematic review of 17 studies (involving 1484 women) on vaginal cone use for SUI treatment concluded that weighted vaginal cones are better than no active treatment and with similar effectiveness to PFMT.…”

Fisioterapia para consciência perineal: uma comparação entre as cinesioterapias com toque digital e com auxílio do biofeedback

“…Entretanto, a di iculdade desse tipo de tratamento ocorre, muitas vezes, em função da incapacidade das pacientes em distinguir corretamente os músculos do assoalho pélvico, isto é, elas promovem contrações de outros músculos não relacionados, tais como o reto abdominal, o glúteo máximo e o adutor da coxa (25). Na presente pesquisa, isso foi bastante observado, ou seja, inicialmente, 90% das pacientes acompanhadas utilizavam a musculatura acessória quando solicitada a contração da região, e, no im, 90% delas deixaram de utilizá--la, comprovando, mais uma vez, a necessidade de Já Glavind et al (12) utilizaram o biofeedback durante quatro sessões, tempo idêntico ao usado em nossa pesquisa, e depois orientaram as pacientes a realizarem os exercícios em casa.…”

Management of Urinary Incontinence in the Elderly

“…Training is started with the lowest weight for 15 min twice a day. Objec tive improvement or cure rates of 70% are reported after 1 month in selected patients [18].…”