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Huang Y, Huang Z, Ou Y, Yin L, Sun Y, Zong H. Meta-analysis of the therapeutic effect of electrical stimulation combined with pelvic floor muscle exercise on female pelvic floor dysfunction. Eur J Med Res 2024; 29:380. [PMID: 39039596 PMCID: PMC11265018 DOI: 10.1186/s40001-024-01979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/15/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVES To systematically evaluate the therapeutic effect of electrical stimulation combined with pelvic floor muscle exercise on female pelvic floor dysfunction (PFD). METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was applied. A computer-based retrieval was performed in the databases of PubMed, Web of Science, Embase, and Cochrane Library from database establishment to September 15, 2023, to identify randomized controlled trials on electrical stimulation combined with pelvic floor muscle function exercise on female PFD. Literature screening, data extraction, and quality evaluation were performed independently by two researchers, and meta-analysis was performed using the statistical software Stata15.0. RESULTS 1. In total, 12 randomized controlled trials were included, involving 721 female patients. The overall quality of methodologies employed in the included studies was relatively high. 2. Meta-analysis results showed that electrical stimulation combined with pelvic floor muscle exercise could effectively mitigate the severity of female PFD (SMD = -1.01, 95% CI - 1.78, - 0.25, P < 0.05). 3. This combination treatment demonstrated a significant positive effect on the improvement of pelvic floor muscle strength in female patients (P < 0.05); however, it had no significant effect on the improvement in quality of life (P > 0.05). CONCLUSIONS Compared with pelvic floor muscle exercise alone, electrical stimulation combined with pelvic floor muscle exercise could effectively mitigate the severity of female PFD. It had a notable positive impact on enhancing pelvic floor muscle strength in female patients, although it did not significantly improve quality of life. Future high-quality studies are warranted.
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Affiliation(s)
- Yaqin Huang
- West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Zhoulu Huang
- West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Yi Ou
- West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Lin Yin
- West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Yuxiao Sun
- West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Huiyan Zong
- West China Hospital, Sichuan University, Chengdu, 610000, China.
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China.
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Albayrak H, Atli E, Aydin S, Ozyemisci-Taskiran O. Successful outcome following a multimodal pelvic rehabilitation program in a woman with neurogenic bladder and bowel dysfunction: A case report. Physiother Theory Pract 2024; 40:1083-1090. [PMID: 36369853 DOI: 10.1080/09593985.2022.2144561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurogenic bladder and bowel dysfunctions lead to physical, social, and emotional disability and affects one's quality of life. Initial treatment is conservative including several rehabilitation techniques such as pelvic floor muscle training, biofeedback, electrical stimulation, and posterior tibial nerve stimulation. OBJECTIVE In this case report, a 45-year-old woman with neurogenic bladder and bowel dysfunction was presented. CASE DESCRIPTION Her urinary and fecal incontinence symptoms began twenty years before this episode of care, after an incomplete spinal cord injury secondary to spinal ependymoma and syringomyelia. She discontinued medical treatments due to side effects and ceased intermittent catheterization. A multimodal pelvic rehabilitation program was administered consisting of posterior tibial nerve stimulation, active pelvic floor muscle training accompanied by biofeedback, and electrical stimulation of pelvic floor muscles. OUTCOMES There were clinically important favorable differences in the scores of King's health questionnaire (reductions in symptom severity from 25 to 18 and in each of the impact of incontinence, physical and social limitations, personal relationships, sleep/energy, and severity measures from 100 to 67), pelvic floor distress inventory (decreased from 257 to 146) and female sexual function index (increased from 15.1 to 25.1) after 12 weeks of a multimodal pelvic rehabilitation program. Manual muscle tests demonstrated improvements in pelvic floor muscle strength and endurance. CONCLUSION A 12-week multimodal pelvic rehabilitation program reduced urinary and fecal incontinence symptoms, together with improvements in her sexual life and alleviation of neuropathic pain.
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Affiliation(s)
- Havvanur Albayrak
- Department of Physical Medicine and Rehabilitation, Koç University Hospital, Topkapi, Turkey
| | - Ecenur Atli
- Department of Physical Medicine and Rehabilitation, Koç University Hospital, Topkapi, Turkey
| | - Serdar Aydin
- Department of Obstetric and Gynecology, Koç University School of Medicine, Topkapi, Turkey
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Parra NS, Jaramillo AP, Zambrano J, Segovia D, Castells J, Revilla JC. The Effectiveness of Pelvic Floor Muscle Exercise in Urinary Incontinence: A Systematic Literature Review and Meta-Analysis. Cureus 2023; 15:e45011. [PMID: 37720131 PMCID: PMC10501848 DOI: 10.7759/cureus.45011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/19/2023] Open
Abstract
Urinary incontinence (UI) is a prevalent health concern in females over 60, but it is prevalent in a smaller percentage of males. The medical and social elements of UI are crucial. This disorder may cause embarrassment and low self-esteem, reducing social and physical activities. Consequently, this may impair healthy aging. Researchers have shown that pelvic floor muscle training (PFMT) may improve UI symptoms in middle-aged, older, and young people. Clinical practice highlights the importance of PFMT for UI due to its low cost-effectiveness. To assess PFMT's overall efficacy, we conducted a systematic review of the literature (SRL) and a meta-analysis (MA) of randomized clinical trials (RCTs). The previous 10 years of published material were combed using the online databases the Cochrane Library, PubMed, and Google Scholar. Eligible total studies were RCTs referring to the effectiveness of PFMT. The pooled incidence, risk ratio, and 95% confidence interval (CI) of the effectiveness of PFMT were calculated using the fixed effects model. Given the possibility of a between-study variance, we used the fixed effects model rather than the random effects model.
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Affiliation(s)
- Nicole S Parra
- Internal Medicine, Pontificia Universidad Católica del Ecuador, Quito, ECU
| | | | - Jhon Zambrano
- Emergency, Universidad Tech, Santa Cruz de Tenerife, ESP
| | - Diego Segovia
- Internal Medicine, Pontificia Universidad Católica del Ecuador, Quito, ECU
| | - Javier Castells
- Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, ECU
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4
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Gao L, Xie B, Zhu H, Zhang D, Fu X, Li H, Zhen M, Qin B, Chen W, Mao X, Kong L, Wang J, Wu G, Sun X. Association between pelvic floor muscle strength and sexual function based on PISQ-12-an analysis of data from a multicenter cross-sectional study on 735 nulliparae during pregnancy. Front Med (Lausanne) 2023; 10:1093830. [PMID: 37181368 PMCID: PMC10168537 DOI: 10.3389/fmed.2023.1093830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/20/2023] [Indexed: 05/16/2023] Open
Abstract
Background Pelvic floor muscle strength is well-known to be associated with female sexual function. However, there were a few studies that reported on the relationship between pelvic floor muscle strength and female sexual function in pregnant women, and the presented results were inconsistent. Nulliparae represent a specific cohort with simplicity to exclude confounding factors that are caused by parity. The present study aimed to explore the association of pelvic floor muscle strength and sexual function based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) of nulliparae during pregnancy. Methods This is the second analysis of the baseline data from a randomized controlled trial (RCT), which aimed to study the protective efficacy of pelvic floor muscle training on stress urinary incontinence at 6th week postpartum (registration number: ChiCTR2000029618). Nulliparae aged 20-40 years with singleton pregnancy before 16 weeks of gestation were enrolled in this study, and data, including participants' demographic information, the Modified Oxford Scale (MOS), and PISQ-12, were collected. Eligible nulliparae were divided into two groups: Group MOS > 3 and Group MOS ≤ 3. Demographic information of the two groups was compared. Sexual function based on the PISQ-12 scores of the two groups was compared. A comparison of the PISQ-12 scores between the two groups was calculated by the Mann-Whitney U-test using SPSS version 23.0. Results A total of 735 eligible nulliparae were enrolled in this study. Along with MOS grading up, PISQ-12 scores tended to get lower. Of the 735 nulliparae, there were 378 and 357 participants included in Group MOS > 3 and Group MOS ≤ 3, respectively. The PISQ-12 scores of Group MOS > 3 were significantly lower than those of Group MOS ≤ 3 (11 vs. 12, p < 0.001). The scores of the frequency of feeling sexual desire, orgasm achievement, sexual excitement, sexual activity satisfaction, sexual intercourse pain, fear of urinary incontinence, and negative emotion reactions with the sexual intercourse of Group MOS > 3 were lower than those of Group MOS ≤ 3 (p < 0.05). Conclusion Pelvic floor muscle strength was positively associated with sexual function based on the questionnaire of young nulliparae during their first trimester. Up to half of the nulliparae during the first trimester were suffering from weak pelvic floor muscle strength and nearly a quarter of the nulliparae were facing this weakness combined with sexual dysfunction. Trial registration This study has been registered at http://www.chictr.org.cn (registration number: ChiCTR2000029618).
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Affiliation(s)
- Lei Gao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- The Key Laboratory of Female Pelvic Floor Disorders, Peking University People's Hospital, Beijing, China
| | - Bing Xie
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- The Key Laboratory of Female Pelvic Floor Disorders, Peking University People's Hospital, Beijing, China
| | - Hongmei Zhu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- The Key Laboratory of Female Pelvic Floor Disorders, Peking University People's Hospital, Beijing, China
- Department of Sports Medicine and Rehabilitation, Beijing Sports University, Beijing, China
| | - Di Zhang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- The Key Laboratory of Female Pelvic Floor Disorders, Peking University People's Hospital, Beijing, China
| | - Xiuhong Fu
- Department of Obstetrics and Gynecology, Henan Key Laboratory of Fertility Protection and Aristogenesis, Luohe, China
- Department of Obstetrics and Gynecology, Luohe Central Hospital of Henan Province, Luohe, China
| | - Hongjuan Li
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Min Zhen
- Department of Obstetrics and Gynecology, Fangshan District Beijing Maternal and Child Health Hospital, Beijing, China
| | - Baoling Qin
- Department of Obstetrics and Gynecology, Beijing Fengtai District Maternal and Child Health Hospital, Beijing, China
| | - Weipeng Chen
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, China
| | - Xuying Mao
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lingrui Kong
- Department of Obstetrics and Gynecology, Capital Medical University Mentougou Teaching Hospital, Beijing, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- The Key Laboratory of Female Pelvic Floor Disorders, Peking University People's Hospital, Beijing, China
| | - Guizhu Wu
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
- The Key Laboratory of Female Pelvic Floor Disorders, Peking University People's Hospital, Beijing, China
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Zang Y, Bai M, Wang L, Zhang M, Li L. Effects of acupuncture and pelvic floor muscle training on bladder dysfunction after spinal cord injury: A meta-analysis. Medicine (Baltimore) 2023; 102:e33048. [PMID: 36897726 PMCID: PMC9997793 DOI: 10.1097/md.0000000000033048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/31/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE We aimed to systematically review and quantify the association between acupuncture and pelvic floor muscle exercise and bladder dysfunction rehabilitation in individuals with spinal nerve injury. METHODS A meta-analysis was conducted using an evidence-based nursing analysis method based on clinical evidence. China National Knowledge Infrastructure, PubMed, VIP database, Wan Fang database, Cochrane Library, and other databases were searched by computer from January 1, 2000 to January 1, 2021. The literature was searched for clinical randomized controlled trials on acupuncture stimulation, pelvic floor muscle function training, and bladder function recovery training after spinal cord nerve injury. Two reviewers independently used The Cochrane Collaboration recommended randomized controlled trial risk of bias assessment tool to evaluate the quality of the literature. Then, the meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 20 studies were included, with a total sample size of 1468 cases, including 734 patients in the control group and 734 patients in the experimental group. The results of our meta-analysis showed that acupuncture treatment [OR = 3.98, 95% CI (2.77, 5.72), Z = 7.49, P < .001] and pelvic floor muscle treatment [OR = 7.63, 95% CI (4.47, 13.04), Z = 7.45, P < .001] was statistically significant. CONCLUSION Acupuncture and pelvic floor muscle exercise are effective intervention and treatment methods, which have obvious effects on rehabilitation treatment of bladder dysfunction after spinal nerve injury.
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Affiliation(s)
- Y.T. Zang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - M.J. Bai
- School of Nursing, Inner Mongolia Medical University, Hohhot, China
| | - L. Wang
- School of Nursing, Inner Mongolia Medical University, Hohhot, China
| | - M.X. Zhang
- Ordos Institute of Applied Technology, Ordos, China
| | - L. Li
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Sarmento ALC, Sá BS, Vasconcelos AG, Arcanjo DDR, Durazzo A, Lucarini M, Leite JRDSDA, Sousa HA, Kückelhaus SAS. Perspectives on the Therapeutic Effects of Pelvic Floor Electrical Stimulation: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14035. [PMID: 36360918 PMCID: PMC9658412 DOI: 10.3390/ijerph192114035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Pelvic, perineal, and nervous lesions, which derive principally from pregnancy and childbirth, may lead to pelvic floor dysfunctions, such as organ prolapses and lesions in the nerves and muscles due to muscle expansion and physiology. It is estimated that 70% of women affected by this clinical picture have symptoms that do not respond to the classical treatments with antimuscarinic and anticholinergic drugs. Therefore, resorting to efficient alternatives and less invasive methods is necessary to assist this public health problem that predominantly affects the female population, which is more susceptible to the risk factors. This study aimed to perform an updated and comprehensive literature review focused on the effects of pelvic floor electrical stimulation, considering new perspectives such as a correlation between electric current and site of intervention and other molecular aspects, different from the present reviews that predominantly evaluate urodynamic aspects. For that purpose, PubMed and ScienceDirect databases were used to perform the search, and the Methodi ordinatio method was applied. With well-researched therapeutic effects, electrical stimulation induced promising results in histological, nervous, and molecular evaluations and spinal processes, which showed beneficial results and revealed new perspectives on ways to evoke responses in the lower urinary tract in a non-invasive way. Thus, it is possible to conclude that this type of intervention may be a non-invasive alternative to treat pelvic and perineal dysfunctions.
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Affiliation(s)
- Ana Lúcia Carneiro Sarmento
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
| | - Bruno Silva Sá
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
- Department of Biomedicine, University Centre of the Federal District (UDF), Brasília 70390-045, DF, Brazil
| | - Andreanne Gomes Vasconcelos
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
- Department of Biomedicine, University Centre of the Federal District (UDF), Brasília 70390-045, DF, Brazil
| | - Daniel Dias Rufino Arcanjo
- Laboratory of Functional and Molecular Studies in Physiopharmacology (LAFMOL), Department of Biophysics and Physiology, Federal University of Piauí (UFPI), Teresina 64049-550, PI, Brazil
| | - Alessandra Durazzo
- CREA-Research Centre for Food and Nutrition, Via Ardeatina 546, 00178 Rome, Italy
| | - Massimo Lucarini
- CREA-Research Centre for Food and Nutrition, Via Ardeatina 546, 00178 Rome, Italy
| | | | - Hugo Alves Sousa
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
| | - Selma Aparecida Souza Kückelhaus
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
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Image Enhancement Algorithm-Based Ultrasound on Pelvic Floor Rehabilitation Training in Preventing Postpartum Female Pelvic Floor Dysfunction. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8002055. [PMID: 35495879 PMCID: PMC9042637 DOI: 10.1155/2022/8002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
In order to explore the application value of image enhancement algorithm in evaluating pelvic floor rehabilitation training in the prevention of postpartum female pelvic floor dysfunction (FPFD), 70 patients with FPFD were selected as the study subjects and randomly divided into two groups. One group received routine nursing (control group, n = 35), and the other group received pelvic floor rehabilitation training based on routine nursing (experimental group, n = 35). In ultrasound images based on an image enhancement algorithm, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Pelvic Floor Distress Inventory-20 (PFDI-20) were used to evaluate the efficacy. The results showed that after image enhancement algorithm processing, the image signal-to-noise ratio (SNR), peak signal-to-noise ratio (PSNR), and structural similarity index (SSIM) of ultrasound images of patients with FPFD were significantly improved (P < 0.05); the mean square error (MSE) was significantly decreased (P < 0.05); the diagnostic accuracy of FPFD in the original ultrasound images was 73.34%, and that after image enhancement algorithm processing was significantly improved to be 89.86% (P < 0.05). In addition, the overall clinical response rate of FPFD in the experimental group (82.86%) was obviously higher than that in the control group (51.43%) (P < 0.05). After rehabilitation training, the ICIQ-SF and PFDI-20 scores of patients with FPFD in the two groups suggested a significant decrease (P < 0.05). In summary, using an image enhancement algorithm has a good application prospect in evaluating pelvic floor rehabilitation training in preventing postpartum FPFD and is worthy of further promotion.
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The association between amateur running with varying degrees of effort and sexual function among women. Int Urogynecol J 2022; 33:1659-1665. [PMID: 35412070 DOI: 10.1007/s00192-022-05197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sports and physical activity are known risk factors for altered pelvic floor function, which may affect sexual activity. The aim of this study was to examine the impact of amateur running on sexual function. METHODS Amateur runners were contacted through social media. Their pelvic floor dysfunction (PFD), sexual function and quality of life were evaluated by self-reported validated questionnaires (PFDI-20, PISQ-12, IIQ-7). They were divided by degrees of effort into 'High effort' and 'Moderate effort.' The differences between the two groups were examined by Mann-Whitney U, t and chi-square tests. RESULTS One hundred eighty amateur runners were included. No significant differences in the sexual function were found between the two groups. The 'High effort' group reported experiencing higher intensity orgasms compared with women in the 'Moderate effort' group, and a correlation was found between the weekly running distance and intensity of orgasm that they experienced (p = 0.004). CONCLUSIONS High effort physical activity may be associated with improved orgasm, which may be explained by better clitoral circulation and better function of the pelvic floor muscles. Clinicians that treat symptoms related to PFD and sexual dysfunction may raise awareness of the advantages of physical activity and pelvic floor muscle training and rehabilitation, which may improve tone and circulation and hence sexual function.
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9
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Polat Dunya C, Tülek Z, Kürtüncü M, Gündüz T, Panicker JN, Eraksoy M. Evaluating the effects of transcutaneous tibial nerve stimulation or pelvic floor muscle training on sexual dysfunction in female multiple sclerosis patients reporting overactive bladder. Neurourol Urodyn 2021; 40:1661-1669. [PMID: 34174117 DOI: 10.1002/nau.24733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/15/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023]
Abstract
AIMS Sexual dysfunction (SD) is common in female patients with multiple sclerosis (MS) reporting overactive bladder (OAB) symptoms. The aim of the study was to evaluate the effects of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on SD in female patients with MS reporting OAB symptoms. METHODS Patients with overactive bladder and SD were allocated to receive TTNS or PFMT daily. Overactive bladder symptoms, sexual functions, and sexual quality of life were assessed at baseline and 6th weeks. Female Sexual Function Index (FSFI), Overactive Bladder Questionnaire (OABv-8), and Sexual Quality of Life-Female (SQoL-F) questionnaires were used. RESULTS Thirty patients (TTNS = 10, PFMT = 20) were included in the study. Compared to baseline, total FSFIOABv-8, and SQoL-F scores improved in both TTNS (p = 0.005, p = 0.011, p = 0.444, respectively) and PFMT (p = 0.002, p = 0.001, p = 0.001, respectively) groups. Between-group comparisons did not show any significant differences. CONCLUSION This study demonstrates the efficacy of both TTNS and PFMT for improving sexual function in female MS patients with OAB symptoms, but did not show superiority of any particular method. Further studies are required to investigate the differences between these two non-invasive methods.
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Affiliation(s)
- Cansu Polat Dunya
- Division of Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zeliha Tülek
- Division of Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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10
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Takahashi S, Takei M, Asakura H, Gotoh M, Ishizuka O, Kato K, Koyama M, Takeyama M, Tomoe H, Yamanishi T, Yokoyama O, Yoshida M, Yoshimura Y, Yoshizawa T. Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition). Int J Urol 2021; 28:474-492. [PMID: 33650242 DOI: 10.1111/iju.14492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100 mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100 mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masami Takeyama
- Urogynecology Center, First Towakai Hospital, Takatsuki, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasukuni Yoshimura
- Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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11
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Effects of surface electrical stimulation during sitting on pelvic floor muscle function and sexual function in women with stress urinary incontinence. Obstet Gynecol Sci 2020; 63:370-378. [PMID: 32489983 PMCID: PMC7231947 DOI: 10.5468/ogs.2020.63.3.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 11/08/2022] Open
Abstract
Objective Dysfunction of the pelvic floor muscles (PFM) is associated with sexual dysfunction in women with stress urinary incontinence (SUI). The EasyK7 device was developed to stimulate the PFM by surface electrical stimulation during sitting (SESdS). We investigated the effects of SESdS on PFM function and sexual function in women with SUI. Methods Women with SUI were randomized into the SESdS and control groups. PFM function and sexual function were assessed using a perineometer and the pelvic organ prolapse–urinary incontinence sexual function questionnaire (PISQ), respectively. After 8 weeks, the groups were compared using either analysis of covariance with the baseline values as covariates or the paired Student's t-test. Results The final analysis included 16 subjects from each group. There were significant differences between the SESdS and control groups after the intervention, as well as within the SESdS group between the pre- and post-intervention measurements. The P-values for the differences in PFM measurements between the groups, and between the pre- and post- intervention measurements within the SESdS group, were 0.001 and 0.004 for power, 0.015 and 0.011 for strength, and 0.012 and 0.034 for endurance, respectively. In addition, in the PISQ, there were significant differences between the groups and between the pre- and post-intervention measurements within the SESdS group in the partner-related domain (between groups: P=0.003; within SESdS group: P=0.024) and total score (between groups: P<0.001; within SESdS group: P=0.001). Conclusion SESdS can improve PFM function and sexual function in women with SUI. Trial Registration Clinical Research Information Service Identifier: KCT0003357
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Pelvic Floor Dysfunction in Women. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Neves da Costa J, Oliveira Lopes MV, Baena de Moraes Lopes MH. Simultaneous Concept Analysis of Diagnoses Related to Urinary Incontinence. Int J Nurs Knowl 2020; 31:109-123. [DOI: 10.1111/2047-3095.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Juliana Neves da Costa
- School of Nursing (FEnf)Universidade Estadual de Campinas (Unicamp) Campinas São Paulo Brazil
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Walters SJ, Jacques RM, Dos Anjos Henriques-Cadby IB, Candlish J, Totton N, Xian MTS. Sample size estimation for randomised controlled trials with repeated assessment of patient-reported outcomes: what correlation between baseline and follow-up outcomes should we assume? Trials 2019; 20:566. [PMID: 31519202 PMCID: PMC6743178 DOI: 10.1186/s13063-019-3671-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are now frequently used in randomised controlled trials (RCTs) as primary endpoints. RCTs are longitudinal, and many have a baseline (PRE) assessment of the outcome and one or more post-randomisation assessments of outcome (POST). With such pre-test post-test RCT designs there are several ways of estimating the sample size and analysing the outcome data: analysis of post-randomisation treatment means (POST); analysis of mean changes from pre- to post-randomisation (CHANGE); analysis of covariance (ANCOVA). Sample size estimation using the CHANGE and ANCOVA methods requires specification of the correlation between the baseline and follow-up measurements. Other parameters in the sample size estimation method being unchanged, an assumed correlation of 0.70 (between baseline and follow-up outcomes) means that we can halve the required sample size at the study design stage if we used an ANCOVA method compared to a comparison of POST treatment means method. So what correlation (between baseline and follow-up outcomes) should be assumed and used in the sample size calculation? The aim of this paper is to estimate the correlations between baseline and follow-up PROMs in RCTs. Methods The Pearson correlation coefficients between the baseline and repeated PROM assessments from 20 RCTs (with 7173 participants at baseline) were calculated and summarised. Results The 20 reviewed RCTs had sample sizes, at baseline, ranging from 49 to 2659 participants. The time points for the post-randomisation follow-up assessments ranged from 7 days to 24 months; 464 correlations, between baseline and follow-up, were estimated; the mean correlation was 0.50 (median 0.51; standard deviation 0.15; range − 0.13 to 0.91). Conclusions There is a general consistency in the correlations between the repeated PROMs, with the majority being in the range of 0.4 to –0.6. The implications are that we can reduce the sample size in an RCT by 25% if we use an ANCOVA model, with a correlation of 0.50, for the design and analysis. There is a decline in correlation amongst more distant pairs of time points.
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Affiliation(s)
- Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Richard M Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | | | - Jane Candlish
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Nikki Totton
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Mica Teo Shu Xian
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
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Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review. J Gen Intern Med 2019; 34:1615-1625. [PMID: 31062225 PMCID: PMC6667523 DOI: 10.1007/s11606-019-05028-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/06/2019] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urinary incontinence (UI) is a common malady in women. Numerous nonsurgical treatments are available, each associated with risk of adverse events (AEs). METHODS We systematically reviewed nonsurgical interventions for urgency, stress, or mixed UI in women, focusing on AEs. We searched MEDLINE®, Cochrane Central Trials Registry, Cochrane Database of Systematic Reviews, and Embase® through December 4, 2017. We included comparative studies and single-group studies with at least 50 women. Abstracts were screened independently in duplicate. One researcher extracted study characteristics and results with verification by another independent researcher. When at least four studies of a given intervention reported the same AE, we conducted random effects model meta-analyses of proportions. We also assessed the strength of evidence. RESULTS There is low strength of evidence that AEs are rare with behavioral therapies and neuromodulation, and that periurethral bulking agents may result in erosion and increase the risk of voiding dysfunction. High strength of evidence finds that anticholinergics and alpha agonists are associated with high rates of dry mouth and constitutional effects such as fatigue and gastrointestinal complaints. Onabotulinum toxin A (BTX) is also associated with increased risk of urinary tract infections (UTIs) and voiding dysfunction (moderate strength of evidence). DISCUSSION Behavioral therapies and neuromodulation have low risk of AEs. Anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. BTX is associated with UTIs and voiding dysfunction. Periurethral bulking agents are associated with erosion and voiding dysfunction. These AEs should be considered when selecting appropriate UI treatment options. AE reporting is inconsistent and AE rates across studies tended to vary widely. Trials should report AEs more consistently.
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Jia X, Rana N, Crouss T, Whitmore KE. Gynecological associated disorders and management. Int J Urol 2019; 26 Suppl 1:46-51. [PMID: 31144734 DOI: 10.1111/iju.13974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic pelvic pain syndrome is complex and involves multiple organ systems. The gynecological aspects of chronic pelvic pain syndrome can be divided into four different areas: intra-abdominal, vaginal, pelvic floor muscles and sexual pain. This article provides an overview of gynecological evaluation in patients with chronic pelvic pain and reviews the most common gynecological diagnoses and their management. METHODS An extensive review of the literature including guidelines from the International Continence Society, the European Association of Urology, and the International Association for the Study of Pain was performed. RESULTS Gynecological evaluation of patients with chronic pelvic pain begins with a thorough history and physical examination. Laboratory tests, imaging studies and diagnostic procedures can be used as adjuncts to make a diagnosis. Treatment modalities include physical therapy, medications, trigger points injections, and surgery. CONCLUSION Common gynecological diagnoses of chronic pelvic pain include endometriosis, adenomyosis, vulvodynia, high tone pelvic floor dysfunction, and genitopelvic pain/penetration disorder. Gynecology is one of the many systems that can be associated with chronic pelvic pain. Managing patients with chronic pelvic pain requires a multimodal and multidisciplinary approach.
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Affiliation(s)
- Xibei Jia
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Neha Rana
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Tess Crouss
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Kristene E Whitmore
- Division of Female Pelvic Medicine and Reconstructive surgery and Urology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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