Neuromodulation techniques: a comparison of available and new therapies

Long-term efficacy of electrical pudendal nerve stimulation for urgency-frequency syndrome in women

INTRODUCTION AND HYPOTHESIS

Electrical pudendal nerve stimulation (EPNS) was developed by combining the advantages of pudendal neuromodulation (PNM) and percutaneous tibial nerve stimulation (PTNS) and incorporating the technique of deep insertion of long acupuncture needles. The purpose of this study is to show the long-term efficacy of EPNS in treating urgency-frequency syndrome (UFS) in women.

METHODS

One hundred and six consecutive female UFS patients were enrolled and treated with EPNS. Long acupuncture needles were deeply inserted into four sacral points and electrified to stimulate the pudendal nerves. Evaluation of therapeutic effects was based on a questionnaire (including questions on storage, voiding, and postmicturition symptoms). Patients with ≥50 % posttreatment symptom improvement were followed up for at least 60 months.

RESULTS

Complete resolution and ≥50 % improvement rate were 42.5 % and 85.8 %, respectively, in the 106 patients after a mean of 21.2 sessions of EPNS treatment. Of the 91 patients with ≥50 % posttreatment improvement, 62 (29 with complete resolution, 15 with marked improvement, and 18 with moderate improvement) were available for follow-up at 60-126 (mean 99.5; median 98) months after the end of EPNS treatment. Of these 62 patients, 35 maintained the posttreatment effect, 18 changed from better to complete resolution, and seven changed back to <50 % improvement; only four of whom changed to <25 % improvement.

CONCLUSIONS

EPNS combines the advantages of PNM (better effect) and PTNS (minimally invasive, easily applicable, and well tolerated) in treating UFS. It has a good long-term therapeutic effect on UFS in women.

Pelvic floor muscle training for urgency urinary incontinence in women: a systematic review

The objective of this study is to evaluate the effectiveness of existing physiotherapy modalities for the treatment of urge urinary incontinence (UUI). A systematic review was performed for primary studies of physiotherapy techniques for UUI published in English between 1996 and August 2010 in major electronic databases. Only randomized clinical trials that reported outcomes separately for women with UUI were included. Outcomes assessed were reduction in UUI, urinary frequency, and nocturia. Data from 13 full-text trials including the modalities of pelvic floor muscles exercises with or without biofeedback, vaginal electrical stimulation, magnetic stimulation, and vaginal cones were analyzed. The methodologic quality of these trials was fair. Significant improvement in UUI was reported for all physiotherapy techniques except vaginal cone therapy. There are insufficient data to determine if pelvic physiotherapy improves urinary frequency or nocturia. Evidence suggests that physiotherapy techniques may be beneficial for the treatment of UUI.