Which combination is most effective in women with idiopathic overactive bladder, including bladder training, biofeedback, and electrical stimulation? A prospective randomized controlled trial

Abstract

Objective: To evaluate the efficacy of single and combined use of biofeedback (BF) and electrical stimulation (ES) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with idiopathic overactive bladder (OAB). Material and Methods: Seventy women were randomized into four groups as follows: Group 1 received BT alone (n = 18), Group 2 received BT + BF (n = 17), Group 3 received BT + ES (n = 18), and Group 4 received BT + BF + ES (n = 17). BF and ES were performed 3 days a week, 20 min a day, a total of 24 sessions for 8 weeks. All women were evaluated in terms of incontinence severity (pad test), pelvic floor muscles strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and number of pads), QoL (incontinence impact questionnaire), treatment success (positive response rate), cure/improvement rate, treatment satisfaction (Likert scale), and discomfort level (visual analog scale). Results: At the end of the treatment, severity of incontinence, frequency of voiding, incontinence episodes, and treatment satisfaction significantly improved in Group 3 and Group 4 compared with the other two groups. In Group 3 and Group 4, high statistically significant values were found in cure/improvement and positive response rates as opposed to Group 1 and Group 2. In Group 2 and Group 3, statistically significant improvements were seen in nocturia and QoL compared with Group 1. Moreover, statistically significant improvements in nocturia and QoL were found in Group 4 compared with the other three groups. There was no difference in the discomfort level of application between the groups. Conclusion: We conclude that in the first-line conservative treatment of women with idiopathic OAB: (i) adding BF and/or ES to BT increases treatment effectiveness, (ii) clinical efficiency is greater when the combination

Efficacy of intravaginal electrical stimulation added to bladder training in women with idiopathic overactive bladder: A prospective randomized controlled trial

“…We calculated the sample size using the reduction of urge incontinence episodes after two modalities of treatments (ES and Sham ES) in patients with OAB. As previously published, ES treatment succeeded to reduce incontinence episodes (positive response rate) in 81.3% compared to 32.1% after Sham ES (p=0.001) (9). The optimum sample size should be 28 cases in each arm with a level of significance of 95% (α=5%), a power of 95% (ß=0.05) when an expected 50% or greater improvement of incontinence episodes reported in the previous study (10).…”

“…Up to our knowledge, there are only two studies including BT+IVES treatment arm in women with idiopathic OAB in the literature. The results of these two studies are contradictory (8,9). In the light of our clinical experience, we think that this issue is still open for research.…”

“…It was carried out in 2 steps: a timed voiding and increasing the time between urination considering the voiding diary. At the last stage, the women were encouraged to continue BT (4,5,8,9,12).…”

“…The stimulation parameters were frequency at 10Hz, a 5-10s work-rest cycle and a 100ms pulse width. The symmetric biphasic pulse wave could be delivered over a range of 1-100mA (according to the patient's discomfort level feedback) (9,13,14). IVES sessions were performed by an experienced urogynecologic rehabilitation nurse in Group 2.…”

“…To determine positive response rate, reduction in incontinence episodes was collected from the 3-day bladder diary. Women with ≥50% reduction in incontinence episodes were considered positive responders (9,16). Furthermore, the severity of incontinence, PFM strength, symptom severity, frequency of voiding, nocturia, number of pads as well as QoL was a secondary outcome measure.…”