EFFECT OF FUNCTIONAL CONTINUOUS MAGNETIC STIMULATION FOR URINARY INCONTINENCE

[Application of peripheral magnetic stimulation in physiotherapeutic practice. (A literature review)]

Search and development of new physiotherapeutic technologies of regenerative medicine for the treatment of patients with different diseases is an urgent task of modern medicine.

OBJECTIVE

To analyze scientific data on the effectiveness of the peripheral magnetic stimulation (PMS) application in patients with different diseases.

MATERIAL AND METHODS

An analysis of publications in databases of electronic resources (PEDro, PubMed, Embase, eLibrary, Cochrane Library) over the past 20 years was carried out, the results of PMS application in patients with different nosologies were presented.

RESULTS

The majority of the presented articles confirm the clinical effectiveness of PMS application mainly in patients with diseases of the nervous system, spine and genitourinary system.

CONCLUSION

Further research to confirm the effectiveness of the therapeutic impact of magnetic stimulation in patients with other nosologies is needed.

Evaluation of Possible Side Effects in the Treatment of Urinary Incontinence with Magnetic Stimulation

Background and Objectives: Magnetic stimulation is a type of conservative treatment of urinary incontinence. Our aim was to evaluate the possible side effects of this method. Materials and Methods: We conducted a systematic literature review. The key search terms were urinary incontinence, magnetic stimulation, and female. All known synonyms were used. Results: 255 titles and abstracts were retrieved, and 28 articles met our inclusion criteria. Out of 28 studies, 15 reported no side effects, five reported side effects, and eight did not report anything. There was no significant difference in the incidence of side effects between the sham and active treatment groups. Conclusions: Side effects of magnetic stimulation in comparison to other active treatments are minimal and transient. Among the conservative UI treatment methods, magnetic stimulation is one of the safest methods for the patient and as such a suitable first step in treating UI.

Physical Agent-Based Treatments for Overactive Bladder: A Review

Almost one-fifth of the people in the world experience a decrease in quality of life due to overactive bladder (OAB) syndrome. The main bothersome symptoms are urgency accompanied by urinary frequency and nocturia. This chronic, disabling condition is first managed by reducing fluid intake and pelvic floor muscle training, supplemented with antimuscarinic drugs, if necessary. However, refractory cases often still occur. In more severe cases, invasive surgical interventions can be considered; yet, the success rate is still inconsistent, and there is a high complication rate. This condition is frustrating for patients and challenging for the medical staff involved. Although its pathophysiology has not been fully elucidated, peripheral autonomic somatic and sensory afferent receptors are considered to be involved in this condition. Hence, currently, physical agent-based treatments such as neuromodulation have taken a significant place in the third-line therapy of OAB. The efficacy and safety profiles of electrical and magnetic stimulation continue to evolve. Physical-based agents provide an appealing option owing to their effectiveness and minimal side effects. In addition, more physical therapies using light and shock energy are currently being investigated. Thus, a comprehensive understanding of these modalities is an extremely important aspect to provide the most suitable modalities for patients.

Effectiveness of Magnetic Stimulation in the Treatment of Urinary Incontinence: A Systematic Review and Results of Our Study

Urinary incontinence (UI) is becoming an increasingly common health problem. UI treatment can be conservative or surgical. This paper focuses on the effectiveness of magnetic stimulation (MS) in the treatment of UI. We performed a systematic review in order to combine and compare results with results from our clinical study. A clinical prospective non-randomized study was carried out at the Ljubljana University Medical Center's Gynecology Division. It included 82 randomly selected female patients, irrespective of their UI type. The success rate of using MS in treating UI was based on standardized ICIQ-UI SF questionnaires. Patients completed 10 therapy sessions on MS, and follow-up was performed 3 months after the last therapy session. UI improved after treatment with MS. The ICIQ-UI SF score improved in patients regardless of the type of UI. However, the greatest decrease in post-treatment assessment ICIQ-UI SF scores was seen in patients with stress urinary incontinence (SUI). Based on the findings described above, it can be concluded that MS is a successful non-invasive conservative method for treating UI. Future studies are necessary, all of which should include a large sample size, a control group, an optimal research protocol, pre-treatment analyses, standardization, and longer follow-ups.

Efficacy of magnetic stimulation for female stress urinary incontinence: a meta-analysis

Aim:

This meta-analysis aimed to evaluate the efficacy of magnetic stimulation (MS) in treating female stress urinary incontinence (SUI) and providing an alternative treatment for patients who are unwilling to undergo surgery.

Methods:

Randomized controlled trials (RCTs) that evaluated MS as a remedy for female SUI were retrieved from various electronic databases, including MEDLINE, EMBASE, and the Cochrane Controlled Trial Registry system. Moreover, reference lists for related papers were carefully screened for relevant studies.

Results:

A total of six RCTs evaluating the effect of MS in treating female SUI were included in this study. Compared with the placebo group, the MS group exhibited higher quality-of-life scores [mean difference (MD) 0.59, 95% credibility interval (CI) 0.23–0.95; p = 0.001] and lower International Consultation on Incontinence Questionnaire scores (MD −3.93, 95% CI −5.85 to −2.01; p < 0.0001). Moreover, they exhibited a higher objective cure rate (odds ratio 8.49, 95% CI 3.08–23.37). In addition, MS treatment reduced the number of episodes of urinary incontinence (MD −1.42, 95% CI −2.24 to −0.59; p = 0.0007) and urine loss on pad test (MD −4.67, 95% CI −8.05 to −1.28; p = 0.007). There were no significant treatment-related adverse reactions.

Conclusion:

This study evaluated the efficacy and safety of MS in the treatment of female SUI. The results have important implications for patients who do not wish to undergo surgical therapy. We found that MS treatment for SUI has positive outcomes, however, future studies should aim at establishing the best protocol for optimizing the therapeutic effect.

Effects of magnetic stimulation on urodynamic stress incontinence refractory to pelvic floor muscle training in a randomized sham-controlled study

OBJECTIVE

The aim of the present study was to evaluate the effect of magnetic stimulation on urodynamic stress incontinence refractory to pelvic floor muscle training in a randomized sham-controlled study.

METHODS

Female patients with urodynamic stress incontinence who had not been cured by pelvic floor muscle training were randomly assigned at a ratio of 2 : 1 to either active treatment or sham treatment for 10 weeks. The randomization was made using magnetic cards for individuals indicating active or sham stimulation. The primary endpoint was changes in the number of incontinence episodes/week, with secondary endpoints of the degree of incontinence (in g/day; determined using the pad test), the total score on the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), the ICIQ quality of life (QOL) score, and the abdominal leak point pressure (ALPP) on urodynamic study.

RESULTS

Although 39 patients were enrolled in the study, 9 dropped out, leaving a total patients for analysis (18 in the active treatment group, 12 in the sham treatment group). The number of incontinence episodes/week, the degree of incontinence, total ICIQ-SF score, ICIQ-QOL score, and ALPP were significantly improved after active treatment compared with baseline (all P < .05), but did not change significantly after sham treatment. There was a significant intergroup difference with regard to changes from baseline in the ICIQ-SF and ALPP in favor of the active treatment group (P < .05). There were no significant differences in any other parameters between the 2 groups. Treatment-related adverse events were not found in both groups.

CONCLUSION

Magnetic stimulation was effective in treating urodynamic stress incontinence.

Patients' perception and satisfaction with pulsed magnetic stimulation for treatment of female stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

We evaluated patients' perception and satisfaction with nonsurgical pulsed magnetic stimulation (PMS) for treatment of female stress urinary incontinence (SUI) in a randomized, double-blind, sham-controlled trial.

METHODS

Women with SUI (n = 120) were randomized to either active or sham PMS for 8 weeks (twice/week). Patients answered seven questions on their perception and acceptability, each measured on a 5-point Likert scale. Treatment satisfaction was assessed using two parameters: (i) the single-item question "Overall, please rate how satisfied you are with the treatment" and (ii) Patient Global Impression of Improvement (PGI-I). All adverse events were documented.

RESULTS

A total of 115 patients completed treatments (active: n = 57, sham: n = 58). There were no significant differences between groups in all parameters regarding perception and acceptability (p > 0.05). In terms of treatment satisfaction, a significantly higher proportion of patients in the active group (n = 47/57, 82.4%) were either mostly or completely satisfied compared with those in the sham group (n = 27/58, 46.6%) ((p = 0.001). Similarly, a statistically significantly higher percentage of patients in the active group (n = 39/57, 68.4%) felt much or very much better compared with patients in the sham group (n = 11/58, 19.0%) as measured using the PGI-I (p < 0.001). Three (5.3%) patients in the active group and five (8.6%) in the sham group experienced adverse events (p = 0.72). Regardless of treatment arms, 109 (94.8%) patients would not consider surgical options even if they required further treatment for their condition.

CONCLUSION

PMS was well accepted, well tolerated, and resulted in a high treatment satisfaction among women with SUI.

High-power Magnetotherapy: A New Weapon in Urinary Incontinence?

OBJECTIVE

Urinary incontinence (UI) is one of the most common urinary system diseases that mostly affects women but also men. We evaluated the therapeutic efficacy of functional magnetic stimulation (FMS) as potential UI treatment with improvements in the pelvic floor musculature, urodynamic tests and quality of life.

METHODS

A total of 20 UI patients (10 females and 10 men, mean age 64, 14 years), including 10 with stress UI, four with urgency UI and six with mixed UI, were treated with FMS (20 min/session) twice a week for 3 weeks. The patients' impressions, records in urinary diaries, and scores of three life stress questionnaires (overactive bladder symptom questionnaire [OAB-q], urogenital distress inventory questionnaire-short form [UDI-6], incontinence impact questionnaire-short form [IIQ-7]) were performed pre- and post-treatment.

RESULTS

Significant reductions (P < 0.01) of micturition number and nocturia after magnetic treatment were evidenced. The urodynamic tests recorded a significant increase in cystometric capacity (147 ± 51.3%), in maximum urethral closure pressure (110 ± 34%), in urethral functional length (99.8 ± 51.8%), and in pressure transmission ratio (147 ± 51.3%) values compared with the baseline values.

CONCLUSIONS

These preliminary findings suggest that FMS with Magneto STYM (twice weekly for 3 weeks) improves the UI and may be an effective treatment for this urogenital disease.

Impact of ao-dake-humi, Japanese traditional bamboo foot stimulator, on lower urinary tract symptoms, constipation and hypersensitivity to cold: a single-arm prospective pilot study

Background

Ao-dake-humi is a traditional Japanese bamboo foot stimulator consisting of a half-pipe-shaped step made of bamboo used to stimulate the foot by stepping on it, and is commonly used to promote general health among the elderly in Japan. However, its efficacy has not been reported in the scientific literature. This study was performed to investigate the role of ao-dake-humi focusing on lower urinary tract symptoms (LUTS), constipation, and hypersensitivity to cold (HC).

Methods

Participants with LUTS, constipation, or HC were enrolled in this study. Ao-dake-humi was used twice a day for 28 days. Before and 28 days after starting ao-dake-humi use, international prostate symptom score (IPSS), quality-of-life (QoL) score, and overactive bladder symptom score (OABSS) were measured to evaluate the efficacy of ao-dake-humi on LUTS. To evaluate the objective efficacy of ao-dake-humi on LUTS, a frequency-volume chart (FVC) was plotted in LUTS patients for 3 days. A visual analogue scale (VAS) was used to evaluate the efficacy of ao-dake-humi on constipation (VAS-constipation) and HC (VAS-HC) in the participants with constipation or HC.

Results

A total of 24 participants were enrolled in this study. Twenty-one participants had LUTS, 11 had constipation, and 17 participants had HC. IPSS, especially storage-subscore, QoL score and OABSS, decreased significantly after use of ao-dake-humi. The use of ao-dake-humi increased maximal bladder capacity, resulting in a significant decrease in urinary frequency as determined from the FVC. In accordance with the results of VAS-constipation and VAS-HC, both constipation and HC were significantly relieved after ao-dake-humi use.

Conclusion

The results of this prospective pilot study indicated that ao-dake-humi is safe and has therapeutic efficacy in cases of LUTS, constipation and HC. The possibility of using ao-dake-humi as physical neuromodulation therapy was shown in the management of LUTS, constipation and HC.

Trial registration

UMIN000019333 (UMIN-CTR, Registered October-15-2015) retrospectively registered.

Clinical Guideline for Female Lower Urinary Tract Symptoms

The "Japanese Clinical Guideline for Female Lower Urinary Tract Symptoms," published in Japan in November 2013, contains two algorithms (a primary and a specialized treatment algorithm) that are novel worldwide as they cover female lower urinary tract symptoms other than urinary incontinence. For primary treatment, necessary types of evaluation include querying the patient regarding symptoms and medical history, examining physical findings, and performing urinalysis. The types of evaluations that should be performed for select cases include evaluation with symptom/quality of life (QOL) questionnaires, urination records, residual urine measurement, urine cytology, urine culture, serum creatinine measurement, and ultrasonography. If the main symptoms are voiding/post-voiding, specialized treatment should be considered because multiple conditions may be involved. When storage difficulties are the main symptoms, the patient should be assessed using the primary algorithm. When conditions such as overactive bladder or stress incontinence are diagnosed and treatment is administered, but sufficient improvement is not achieved, the specialized algorithm should be considered. In case of specialized treatment, physiological re-evaluation, urinary tract/pelvic imaging evaluation, and urodynamic testing are conducted for conditions such as refractory overactive bladder and stress incontinence. There are two causes of voiding/post-voiding symptoms: lower urinary tract obstruction and detrusor underactivity. Lower urinary tract obstruction caused by pelvic organ prolapse may be improved by surgery.

Magnetic stimulation for stress urinary incontinence: study protocol for a randomized controlled trial

Background

There is currently a lack of randomized, sham-controlled trials that are adequately powered, using validated outcomes, to allow for firm recommendations on the use of magnetic stimulation for stress urinary incontinence. We report a protocol of a multicenter, randomized, double-blind, sham-controlled parallel-group trial to evaluate the efficacy of magnetic stimulation for stress urinary incontinence.

Methods/Design

One hundred twenty subjects with stress urinary incontinence will be randomized in a 1:1 allocation to either active or sham magnetic stimulation using computer-generated, permuted blocks of variable sizes. Subjects will receive 2 sessions of magnetic stimulation per week for 8 weeks (16 sessions total). The primary outcome is the improvement in severity of involuntary urine loss based on the International Consultation on Incontinence Questionnaire for Urinary Incontinence Short Form at the end of treatment sessions compared with baseline. Secondary outcomes include cure, stress urinary incontinence–related symptoms (incontinence episode frequency, urine loss in 1-hour pad test, pelvic floor muscle strength) and health-related quality of life (Patient Global Impression of Improvement, International Consultation on Incontinence Questionnaire–Lower Urinary Tract Symptoms Quality of Life and EQ-5D). The safety of magnetic stimulation will also be assessed. Besides evaluation of clinical treatment effectiveness, cost-effectiveness analysis using patient-reported outcomes will be performed.

Discussion

This trial is designed to provide pending outcome information on this non-invasive treatment option. We intend to acknowledge the existing flaws in previous clinical trials and determine conclusively whether magnetic stimulation is effective for stress urinary incontinence.

Trial registration

ClinicalTrials.gov Identifier: NCT01924728. Date of Registration: 14 August 2013.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-015-0803-1) contains supplementary material, which is available to authorized users.

The therapeutic efficiency of extracorporeal magnetic innervation treatment in women with urinary tract dysfunction following radical hysterectomy

Data on 32 consecutive women with demonstrable urinary tract dysfunction for at least 6 months following radical hysterectomy (RH) for uterine cervical cancer, who received 24 sessions of extracorporeal magnetic innervation (ExMI) treatment twice-weekly were collected. The 1-h pad test weight decreased from 27.2 g pre-treatment to 12.1 g post-treatment (p < 0.05). Both the median UDI-6 and IIQ-7 scores showed statistically significant improvements (p < 0.001) at every stage of the ExMI treatment and in the 24.2 months mean follow-up duration after treatment. The symptoms of frequency, stress incontinence, urge incontinence and voiding difficulty showed statistically significant improvements (p < 0.001) after 8 and 24 sessions of ExMI treatment. The urodynamic parameters between pre-treatment and post-treatment after 24 sessions revealed no statistically significant changes. Based on the objective and subjective measures observed in this study, 24 sessions of twice-weekly ExMI treatment is an additional non-invasive therapy option for patients with the symptoms of lower urinary tract following RH.

Effect of extracorporeal magnetic energy stimulation on bothersome lower urinary tract symptoms and quality of life in female patients with stress urinary incontinence and overactive bladder

AIMS

The aim of this study was to investigate the efficacy of extracorporeal magnetic stimulation (EMS) for the treatment of bothersome and severe symptoms of stress urinary incontinence (SUI) and overactive bladder syndrome (OAB) in female patients.

MATERIAL AND METHODS

A retrospective review was conducted on patients with SUI and OAB who were referred to EMS therapy. Successful treatment for the bothersome symptoms of OAB and SUI was defined as score ≤1 for questions 2 and 3 on the Urodynamic Distress Inventory-6. The objective cure of SUI and OAB was defined as no urinary leakage during the cough stress test and any urgency, urge incontinence and voiding frequency of less than eight times per 24 h based on the 3-day bladder diary, after the 9 weeks of treatment, respectively.

RESULTS

Ninety-three patients with SUI or OAB underwent a 9-week course of EMS at 20 min twice weekly. Seventy-two (77%) patients completed EMS treatment. Geographical factor and poor economic status were two main factors for dropout. A total of 94.1% (32 of 34) and 86.8% (33 of 38) of subjects had successful treatment for the bothersome symptoms of OAB and SUI, respectively. In contrast, the cure rate for OAB and SUI was only 61.7% and 42.1%, respectively. There was also a significant improvement in both Urogenital Distress Inventory Short Form (bothersome on lower urinary tract symptoms) and the Incontinence Impact Questionnaire Short Form (quality of life) total score in both groups after EMS.

CONCLUSIONS

EMS is a safe and effective alternative method for treating SUI and OAB. Further studies are needed to evaluate the long-term efficacy.

Efficacy of High-frequency Magnetic Stimulation of the Sacral Root in Patients with Urinary Incontinence Following a Radical Prostatectomy

OBJECTIVES

We report on our initial data from a prospective study to determine the efficacy of high-frequency magnetic stimulation on the sacral root (MSSR) for the intractable post-radical prostatectomy, stress urinary incontinence (SUI).

METHODS

A total of 14 men with persistent SUI after a radical prostatectomy underwent treatment once every 2 weeks over a 40-week period for a total of 20 sessions. The outcome was assessed by these variables at baseline, at immediately after the first session, and at immediately after the final (20(th) ) session.

RESULTS

Mean leak episodes (per day) consistently decreased after the first to the final session (from 6.1 ± 2.9 to 3.5 ± 2.6, and to 3.0 ± 2.3, P < 0.01), and it remained to be decreased following 2 months after the final session. The mean pad weight (per h) also decreased after the treatment (but no statistically significant change compared to the pretreatment level). The cystometric bladder capacity at the first desire to void and the capacity at the strong desire to void increased significantly following the high-frequency MSSR (first desire to void: from 146 ± 43 to 182 ± 52 mL; strong desire to void: from 224 ± 69 to 258 ± 60 mL, P < 0.01). No obvious complication was observed in any patients during or after the treatment.

CONCLUSION

This study provides the preliminary evidence that high-frequency MSSR may potentially afford a useful option with minimal invasiveness for the patients with obstinate SUI after a radical prostatectomy.

The use of extracorporeal magnetic innervation for the treatment of stress urinary incontinence in older women: a pilot study

PURPOSE

Stress urinary incontinence (SUI) is a major health problem that has substantial and important effects on health-related quality of life. In recent years, extracorporeal magnetic innervation (ExMI) has become a preferred method of treatment in urinary incontinence. This study presents the effects of ExMI treatment on pelvic floor muscle strength, urinary symptoms, incontinence conditions and quality of life of older women with SUI.

METHODS

A total of 13 patients between the ages of 61 and 69 (mean 65.23 ± 2.8 years) were treated for SUI with ExMI. The following parameters were investigated: urinary symptoms, pelvic floor electromyographic (EMG) activity, 1-h pad test, incontinence conditions utilizing visual analog scale (VAS) and quality of life using Turkish version of the Urogenital Distress Inventory (UDI-6) and the Incontinence Quality of Life Instrument (I-QoL). All assessments were conducted at baseline and at the end of the study. Treatment lasted for 20 min, twice a week and for a total of 6 weeks.

RESULTS

The urinary symptoms and incontinence conditions decreased after the ExMI treatment sessions. The pad test results indicated a reduction in urine loss (p = 0.016). EMG values were improved (p = 0.005). Scores of I-QoL, UDI-6 and VAS were reduced after the treatment, respectively (p = 0.002), (p = 0.002) and (p = 0.006).

CONCLUSION

Extracorporeal magnetic innervation can be considered as it is an alternative, non-invasive and painless treatment method with good compliance for treatment of SUI in older patients.

Long-term effects of extracorporeal magnetic innervations in the treatment of women with urinary incontinence: results of 3-year follow-up

PURPOSE

This study is designed to evaluate the long-term efficacy of extracorporeal magnetic innervation (ExMI) in the treatment of women with urinary incontinence.

METHODS

Our prospective study included a period of 3 years between May 2005 and October 2008. A total of 137 consequent women with stress and urge incontinence were included in the study. Of the patients, 68 had stress incontinence and others had urge incontinence.

RESULTS

All of the patients with stress incontinence were successfully followed up and 32 (47%) were totally dry in negative stress test at the 6 months after ExMI therapy. In the same group, 27(39%) showed improvement in the frequency of daily leak episodes from 3.2 times to 1.2 times. In the urge incontinence group, all of the patients completed the treatment and they were successfully followed up. While 40 (58%) patients were dry and 18 (26%) significantly improved the average number of incontinence episodes decreased from 3.7 times to 1.7 times per day, treatment failed in the remaining 11 (16%) patients at the 6 months. At 6 months, the recurrence rate was 53%.

CONCLUSIONS

At the 6 months after 16 sessions of ExMI had a significant QOL, parallel to decrease in daily pad use and leakage episodes. Only 16 sessions are not effective definitive therapy. The beneficial effects are temporary and there is high recurrence.

Extracorporeal magnetic stimulation for the treatment of stress and urge incontinence in womenResults of 1‐year follow‐up

OBJECTIVE

To evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress and urge urinary incontinence in women.

MATERIAL AND METHODS

A total of 35 patients with stress incontinence and 17 with urge incontinence were enrolled in this study. All patients were evaluated by means of a detailed history of incontinence, a gynecologic examination, urine culture, urinary system ultrasound and a urodynamic study. All patients were asked to keep a 3-day voiding diary. A pad-weighing test was done for each patient at their first visit. For treatment, the patients were seated on a special chair containing a magnetic field generator. Pelvic floor muscle stimulation was performed for 20 min (10 min at 5 Hz and 10 min at 50 Hz) twice a week for a total of 8 weeks. The mean follow-up period was 16.8 months (range 12-32 months). A total of 44 patients completed 1 year of follow-up and were re-evaluated by means of voiding diary, pad-weighing test and cystometric study.

RESULTS

Of the 44 patients, 11 (38%) with stress incontinence and 6 (40%) with urge incontinence were cured 1 year after the treatment. In addition, there was an improvement in symptoms in 12 patients (41%) in the stress group and 7 (47%) in the urge group. Pad weight was reduced from 15.4 to 5.8 g in the stress group and from 12.4 to 4.7 g in the urge group (p = 0.000 and 0.001, respectively). Mean Valsalva leak point pressure was increased from 87.3 +/- 15.9 to 118.0 +/- 11.0 cmH (2) O in the stress group (p = 0.000).

CONCLUSIONS

Extracorporeal magnetic stimulation therapy offers a non-invasive, effective and painless treatment for stress and urge incontinence in women.

Extracorporeal magnetic energy stimulation of pelvic floor muscles for urodynamic stress incontinence of urine in women

The aim of this study was to assess the efficacy, side effects and drop out rate of extra-corporeal magnetic energy stimulation of pelvic floor muscles for urodynamic stress incontinence of urine in women. It was a prospective non-controlled study at 2 district general hospitals in South Wales. It included 48 female patients with urodynamic stress incontinence of urine, who had 16, twice weekly treatment sessions. Pad test was the primary outcome measure and continence diary, King's Health and EuroQol quality of life questionnaires, side effects and drop out were the secondary outcome measures. Assessment was made on recruitment, at the end of treatment sessions and at 3 months follow up. Thirty one patients completed treatment sessions and 27 attended for follow up at 3 months. There was no significant change in outcome measures at the end of treatment or at 3 months follow up. Side effects were encountered by 52.1% of patients and the drop out rate was 35.4%.

Neuromodulation for the treatment of urinary incontinence

Neuromodulation has been reported to be effective for the treatment of stress and urgency urinary incontinence. The cure and improvement rates of pelvic floor neuromodulation in urinary incontinence are 30-50% and 60-90%, respectively. In clinical practice, vaginal, anal and surface electrodes are used for external, short-term stimulation, and sacral nerve stimulation for internal, chronic (long-term) stimulation. The effectiveness of neuromodulation has been verified in a randomized, placebo-controlled study. However, the superiority to other conservative treatments, such as pelvic floor muscle training has not been confirmed. A long-term effect has also been reported. In conclusion, pelvic floor exercise with adjunctive neuromodulation is the mainstay of conservative management for the treatment of stress incontinence. For urgency and mixed stress plus urgency incontinence, neuromodulation may therefore be the treatment of choice as an alternative to drug therapy.

Extracorporeal Magnetic Stimulation is of Limited Clinical Benefit to Women with Idiopathic Detrusor Overactivity: A Randomized Sham Controlled Trial

OBJECTIVES

To observe the effect of both acute and medium-term magnetic stimulation of the pelvic floor on detrusor function amongst women with idiopathic detrusor overactivity (IDO).

METHODS

Two separate studies were undertaken amongst women with a sole diagnosis of IDO. The first study assessed the acute effect of magnetic stimulation (provided by Neocontrol ) on detrusor function during the filling phase of standard cystometry. Multiple filling cycles were performed with stimulation at a different key moment in each. This was done to establish that the device could influence the detrusor. Subsequently, a randomized sham control trial was performed to assess clinical efficacy. A total of 20 treatments, each of 20 minutes duration, were administered over six weeks with follow-up six weeks thereafter. Half the patients received therapy from a genuine device, the others receiving fake treatment on an identical looking/sounding sham device. The sham device contained a deflector plate to degrade the magnetic field and was located in a separate room. Outcome measures included changes in a 24 hour fluid volume chart, urine loss (24 hour pad test) and quality of life instruments.

RESULTS

Amongst 10 patients receiving stimulation during cystometry, volume at first involuntary detrusor contraction during filling rose from a median value of 240ml (Inter-quartile range (IQR) 210-300) to 285ml (IQR 231-320), p = 0.03 and maximum detrusor pressure decreased from 40cm water (IQR 34-45) to 33cm water (IQR 25-41), p<0.01. The RCT was completed by 29 of 44 (66%) recruits. Of these, 15 of 29 (52%) received active treatment and 14 of 29 (48%) sham therapy. Active therapy significantly reduced the number of urge episodes per day, p<0.01. With respect to baseline, actively treated patients experienced significant reduction in voids per day and quality of life but this trend did not reach significance when compared to the sham group, partly due to unexpected difficulty in recruitment which yielded an underpowered sample size for these outcome measures.

CONCLUSIONS

Magnetic stimulation reduces detrusor contractility in the acute phase of administration. Although the treatment was well tolerated and urge episodes reduced following prolonged therapy, no statistically significant improvement was observed in quality of life indices or measured 24 hour urinary loss. The treatment cannot be recommended for women with IDO.

Randomized, double-blind, sham-controlled evaluation of the effect of functional continuous magnetic stimulation in patients with urgency incontinence

AIMS

To evaluate the effect of functional continuous magnetic stimulation (FCMS) on urgency incontinence in randomized, sham-controlled manner.

METHODS

Thirty-nine patients with urgency incontinence, 16 males and 23 females (aged 66.0 +/- 16.5 years), who were refractory to pelvic floor muscle training (PFMT), were randomly assigned either to the treatment schedule performing 10-week active treatment, followed by 4-week non-treatment interval and then by 10-week sham treatment (A-S, n = 20) or to that performing the sham treatment first followed by 10-week active treatment (S-A, n = 19).

RESULTS

At 10 weeks, the number of leaks/week, the total score of the International Consultation on Incontinence-Questionnaire: Short Form (ICIQ-SF), and maximum cystometric capacity (MCC) were significantly improved as compared with the initial levels (P < 0.001, P < 0.001, and P = 0.003, respectively) in the former group, but not in the latter group. Four (20.0%) patients were cured in the A-S group, while no patient was cured in the S-A group. At the end of the A-S schedule (24 weeks of study), the effect of the active treatment was still maintained at a significantly improved level, as compared with the initial level. At the end of the S-A schedule, the number of leaks/week was significantly improved as compared with the initial level and with its 10-week level (P < 0.001 and P = 0.049, respectively), as well as ICIQ-SF total score (P = 0.001 and P = 0.006, respectively). MCC significantly increased from its initial level (P = 0.030).

CONCLUSION

Magnetic stimulation was effective on urgency incontinence in comparison to sham stimulation in this small patient group.

Symptom change in women with overactive bladder after extracorporeal magnetic stimulation: a prospective trial

The purpose of this study was to prospectively evaluate symptom change after discontinuation of extracorporeal magnetic stimulation (EMS) in women with overactive bladder (OAB). A total of 48 women with OAB were included. We applied 10 Hz of repetitive magnetic stimulation with a "magnetic chair" for 20 min, twice weekly for 8 weeks. Changes in OAB symptoms at 2, 12, and 24 weeks after discontinuing the EMS were evaluated. Twenty-seven (56.3%) patients were cured compared with the baseline at 2 weeks: the cure rate was determined as 68.8% (33/48 patients), 56.3% (27/48), and 50% (8/16) for urgency, frequency, and urge incontinence, respectively. The mean number of voids per 24 h was decreased by 42.8% (from 14.5 +/- 4.3, to 8.3 +/- 1.5, P < 0.001) at 2 weeks after treatment. Maximum voided volume did not change significantly, but the mean voided volume increased significantly after stimulation. Twenty-six (96.3%) patients among the 27 patients who achieved a cure at 2 weeks, maintained improvement at 24 weeks; the therapeutic effect on urgency, frequency, and urge incontinence persisted in 26 (78.8%) of 33 patients, 26 (96.3%) of 27 patients, and six (75%) of eight patients, respectively. There were no significant changes in urodynamic parameters. Of the 14 patients with detrusor overactivity, the condition was no longer observed in four (28.6%) patients. EMS has a beneficial effect on women with OAB. Our data suggest EMS may have a significant carry-over effect in well-selected OAB patients.

A critical review on magnetic stimulation: what is its role in the management of pelvic floor disorders?

PURPOSE OF REVIEW

This review looks at the acute effects of magnetic stimulation on urodynamic parameters and reviews the data on its use in the management of urinary incontinence.

RECENT FINDINGS

Reported cure rates for stress incontinence immediately after a course of perineal magnetic stimulation range from 12.5 to 52.9% with good improvement occurring in 32% to 41%. However the effect seems temporary and dependent on the number of sessions. Sacral and pelvic floor magnetic stimulation have also been shown to increase cystometric capacity, inhibit detrusor overactivity and resolve overactive bladder symptoms acutely. Persistence of this effect with symptomatic improvement one week after sacral magnetic stimulation has been demonstrated. How magnetic stimulation suppresses detrusor contraction is not known. Prospective trials with the Neocontrol chair (Neotonus Inc, Marietta, Georgia, USA) also showed symptomatic improvement in 71 to 87% in the short term. However, the longer term data appear mixed.

SUMMARY

Overall, the data available vary too much in terms of treatment protocols, patient mix and symptom severity to determine which group of patients might benefit most and what the optimal stimulation parameters are for each condition. Mean reductions in leak parameters, although statistically significant, may not always be clinically satisfactory. The beneficial effects also appear to be temporary and continuous treatment will probably be required. Further trials are needed to determine the optimum stimulation protocols for different situations and to compare magnetic stimulation with other forms of conservative pelvic floor therapy.

Extracorporeal magnetic stimulation of the pelvic floor: impact on anorectal function and physiology. A pilot study

PURPOSE

This study was designed to investigate the effect of extracorporeal magnetic stimulation on anorectal function and physiology.

METHODS

A pilot study comparing the physiology of ten incontinent (9 females) and five continent (4 females) patients with and without perineal magnetic stimulation (10 Hz and 50 Hz) was performed. The ten incontinent patients were treated with two sessions weekly for five weeks of perineal magnetic stimulation. At treatment completion, precontinent and postcontinent scores and resting and squeeze anal pressure were compared. Patients also reported symptom improvement and satisfaction on a linear analog scale.

RESULTS

The patients' mean age was 57 years. Sitting resting and squeeze anal pressures were significantly greater than lying pressures (P = 0.007, 0.047). Both 10-Hz and 50-Hz stimulation effected a significant increase in anal pressures compared with the baseline resting pressure (P = 0.005). The baseline squeeze pressures were significantly higher than the stimulated pressures compared with 50-Hz pressures (P = 0.022). After six weeks of treatment, there was a statistically significant increase in resting and squeeze anal pressures and a significant decrease in continence scores (P = 0.007, P = 0.008, P = 0.017). The mean percentage subjective improvement was 16 percent, and the mean patient satisfaction score was 3.3, positively correlating with an improvement in the continence score.

CONCLUSIONS

Extracorporeal magnetic stimulation results in a significant increase in anal resting pressure irrespective of pretreatment continence. Although the subjective improvement in continence after treatment is small, there is a significant improvement in both resting pressures and patient continence scores.

Extracorporeal magnetic innervation treatment for urinary incontinence

BACKGROUND

Extracorporeal magnetic innervation (ExMI) is a new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We explored whether this new technology is effective for patients with urge incontinence, as well as those with stress urinary incontinence.

METHODS

We studied 20 patients with urge incontinence and 17 patients with stress urinary incontinence. The Neocontrol system (Neotonus Inc., Marietta, GA) was used. Treatment sessions were for 20 min, twice a week for 8 weeks. Evaluations were performed by bladder diaries, one-hour pad weight testing, quality-of-life surveys and urodynamic studies.

RESULTS

Of the urge incontinence cases, five patients were cured (25.0%), 12 patients improved (60.0%) and three patients did not show any improvement (15.0%). Leak episodes per day reduced from 5.6 times to 1.9 times at 8 weeks (P < 0.05). Eight patients with urge incontinence recurred within 24 weeks after the last treatment (47.1%). Of the stress incontinence cases, nine patients were cured (52.9%), seven patients improved (41.1%) and one patient did not show any improvement (6%). In one-hour pad weight testing, the mean pad weight reduced from 7.9 g to 1.9 g at 8 weeks (P < 0.05). Three patients returned to the baseline values within 24 weeks after the last treatment (17.6%). No side-effects were experienced by any of the patients.

CONCLUSION

Although the results for urge incontinence were less effective than for stress urinary incontinence, ExMI therapy offers a new option for urge incontinence as well as stress urinary incontinence.

Perineal Magnetic Stimulation for Female Urinary Incontinence

Perineal Magnetic Stimulation (PMS) is a new technique in pelvic floor rehabilitation which produces magnetic fields that induce involuntary perineal muscles contraction. Our aims were to evaluate efficacy and tolerability in different types of female urinary incontinence.

Material and Methods

104 consecutive female outpatients complaining of urinary incontinence were enrolled, 53 suffered of stress urinary incontinence (SUI), 37 of mixed urinary incontinence (MUI) and 14 of urge incontinence (UI). The whole treatment consists of two sessions a week of PMS for a total of six weeks.

Results

After one course of treatment 8 patients (8%) were cured, 53 (51%) felt improved and 43 (41%) were unchanged. Better results were obtained in pure stress urinary incontinence, while the presence of bladder overactivity reduced the cure dramatically. If the subjective results were related to the entity of the incontinence, evaluated with the one hour weighting pad test, we could see that only a urinary leakage superior to 50 g makes resulted very poor.

Conclusions

PMS is a new simple perineal rehabilitative technique with instrumental higher costs but less nurse time involvement, with similar results to the usual pelvic floor fisiotherapy and without side effects.

Functional extracorporeal magnetic stimulation as a treatment for female urinary incontinence: 'the chair'

OBJECTIVE

To evaluate, in a prospective study, the efficiency and applicability of functional magnetic stimulation (FMS) of the pelvic floor for treating urinary incontinence in women.

PATIENTS AND METHODS

FMS was provided by a 'magnetic chair'; 24 patients were treated twice weekly for 8 weeks (12 with urge incontinence and 12 with a mixture of urge and stress incontinence). The outcome was assessed urodynamically, by a pad test, and by patient satisfaction.

RESULTS

In 58% of the patients there was an objective improvement in incontinence; three patients were completely dry and 71% reported a subjective improvement (P < 0.001).

CONCLUSION

FMS is a safe, noninvasive and painless treatment for urinary incontinence; it is effective and easy to administer as an outpatient treatment.

Functional magnetic stimulation of the spinal cord?a urodynamic study in healthy humans

AIMS

To study the effects of functional magnetic stimulation of the spinal cord in healthy subjects on somatic and autonomic pathways innervating the anal and the external urethral sphincter, bladder, bladder neck, and rectum.

METHODS

Eight healthy male volunteers gave their written informed consent and underwent functional magnetic stimulation of the thoracolumbar and sacral spinal cord. A two-channel microtip pressure transducer catheter was placed rectally measuring the abdominal and anal sphincter pressure. A three-channel microtip pressure transducer catheter was inserted into the urethra measuring the bladder, the bladder neck, and the external urethral sphincter pressure. A comprehensive protocol of single and repetitive magnetic stimulations was performed. Frequency, location, and duration of stimulation were varied while the intensity of stimulation was adapted to the maximum the subjects could tolerate. In four subjects, the degree of bladder filling was changed and the protocol was repeated when the subjects reported a full bladder and desire to void.

RESULTS

Continuous magnetic stimulation of the thoracolumbar spinal cord and the sacral roots applied with different frequencies (5, 15, 30, 60, 100 Hz) and different duration of stimulation (10, 30, 120 sec) evoked sphincter contraction of both anal and urethral sphincters. The stimulation could not evoke contractions of the bladder, the bladder neck, or the rectum. Also with filled bladder and present desire to void, the magnetic stimulation could not activate autonomic pathways innervating these structures.

CONCLUSIONS

Considering our results, we suggest that in individuals with preserved sensibility magnetic stimulation of the spinal cord with intensities below the pain threshold is ineffective in activating autonomic nerve fibres innervating bladder, bladder neck, and rectum.

Overactive bladder: magnetic versus electrical stimulation

PURPOSE OF REVIEW

To review recent literature on the electrical and magnetic stimulation of the sacral nerve roots and pelvic floor for the treatment of overactive bladder.

RECENT FINDINGS

Overactive bladder is a common condition affecting millions of women worldwide, with a significant effect on quality of life. Electrical stimulation and neuromodulation of the sacral nerve roots have provided a useful alternative for these patients with satisfactory outcomes. The use of the procedures has been limited, however, mainly due to local discomfort/pain or invasiveness of the surgical procedure. Magnetic stimulation can activate deep neural structures by induced electric currents noninvasively. Recent investigations demonstrated that magnetic stimulation of the sacral roots suppressed detrusor overactivity more effectively compared with electrical stimulation. Clinical trials including randomized placebo-controlled studies demonstrated the excellent short-term effect of magnetic stimulation in the treatment of overactive bladder.

SUMMARY

Magnetic stimulation appears to induce inhibitory effects on detrusor overactivity in a similar manner to electrical stimulation, with significant clinical advantages. Although further studies are needed to establish long-term efficacy, magnetic stimulation of the sacral nerve roots may be a promising alternative treatment for overactive bladder.

The acute effect of magnetic stimulation of the pelvic floor on involuntary detrusor activity during natural filling and overactive bladder symptoms

OBJECTIVE

To evaluate the effect of magnetic stimulation of the pelvic floor (MSPF) on involuntary detrusor activity observed during natural filling, and on the overactive bladder symptom complex.

PATIENTS AND METHODS

Eighteen women with detrusor overactivity on conventional cystometry underwent ambulatory urodynamic monitoring over two filling cycles. Fluid intake was standardized, provocative manoeuvres applied at regular intervals and symptoms documented contemporaneously. During the second filling cycle MSPF was delivered whenever the detrusor pressure increased by > 5 cmH2O. The women were subsequently treated with MSPF for 6 weeks; their lower urinary tract symptoms were assessed before and after treatment.

RESULTS

Comparing the second (stimulated) cycle with the first (unstimulated) cycle, cystometric capacity was higher (373 vs 224 mL, P < 0.03). and involuntary detrusor activity of shorter duration (370 vs 427 s, P < 0.82) and lower amplitude (53 vs 63 cmH2O, P < or = 0.05). All women tolerated the procedure comfortably, but nine found it too time-consuming and withdrew. In the nine women who completed treatment there was no consistent change in overactive bladder symptoms.

CONCLUSIONS

In this pilot study, MSPF during natural filling was associated with a decrease in the amplitude of involuntary detrusor contractions and a significant increase in cystometric capacity. However, MSPF had a variable effect on sensations of urgency, both acutely and after treatment, and currently there is no evidence to suggest that MSPF has an enduring effect on symptoms of the overactive bladder.

Magnetic stimulation of the sacral roots for the treatment of urinary frequency and urge incontinence: an investigational study and placebo controlled trial

PURPOSE

We designed an investigational study and placebo controlled trial to evaluate the efficacy of magnetic stimulation of the sacral roots for treating urinary frequency and urge incontinence.

MATERIALS AND METHODS

A total of 48 women 43 to 75 years old (mean age 61) with the complaint of urinary frequency and/or urge incontinence were studied. We applied 15 Hz. repetitive magnetic stimulation of the sacral roots with 50% intensity output for 5 seconds per minute for 30 minutes. Urodynamic investigations during magnetic stimulation were performed in 11 cases to evaluate acute effects for lowering urinary tract function. Another 37 women were enrolled in a placebo controlled study to investigate short-term effects. The mean number of voids daily, mean urine volume per void, number of leaks for 3 days and quality of life score were evaluated before and 1 week after stimulation.

RESULTS

Urodynamic investigations revealed apparent elevation in mean maximum urethral closure pressure plus or minus standard deviation during stimulation in all 11 cases (8.4 +/- 3.6 cm. water, p = 0.00001) and a significant increase in mean bladder capacity after stimulation (58.2 +/- 50.2 ml., p = 0.003). In the placebo controlled study all parameters significantly improved in the active stimulation group. Intergroup comparison showed that mean urine volume per void, mean number of leaks and mean quality of life score improved more significantly in the active than in the sham stimulation group (23.5 +/- 25.6 ml. versus 6.2 +/- 22.5, p = 0.04, 3.6 +/- 4.1 versus 0.4 +/- 1.4, p = 0.04 and 1.4 +/- 1.3 versus 0.4 +/- 0.8, p = 0.01, respectively). No adverse effects were noted in any patients.

CONCLUSIONS

These results suggest that magnetic stimulation of the sacral roots may be useful for treating urinary frequency and urge incontinence.

Effects of magnetic sacral root stimulation on anorectal pressure and volume

PURPOSE

Electrical sacral root stimulation induces defecation in spinal cord injury patients and is currently under examination as a new therapy for fecal incontinence. In contrast to electrical stimulation, magnetic stimulation is noninvasive. To gain more insight into the mechanism of action of sacral root stimulation, we studied the effects of magnetic sacral root stimulation on anorectal pressure and volume in both fecal incontinence and spinal cord injury patients.

METHODS

Three groups were examined: 14 healthy volunteers, 18 fecal incontinence patients, and 14 spinal cord injury patients. Repetitive magnetic sacral root stimulation was performed bilaterally using bursts of five seconds at 5 Hz. Anal and rectal pressure changes and rectal volume changes were measured.

RESULTS

An increase in anal pressure was seen in 100 percent of the control subjects, in 86 percent of the spinal cord injury patients, and in 73 percent of the fecal incontinence patients (P = 0.03). The overall median pressure rise after right-sided and left-sided stimulation was 12 (interquartile range, 8-18.5) and 13 (interquartile range, 6-18) mmHg at the mid anal level. A decrease in rectal volume was provoked in 72 percent of the control subjects, in 79 percent of the spinal cord injury patients, and in 50 percent of the fecal incontinence patients. Overall median volume changes after right-sided and left-sided stimulation were 10 (range, 5-22) and 9 (range, 5-21) percent from baseline volume. An increase in rectal pressure could be measured in 56 percent of the control subjects, 77 percent of the fecal incontinence patients, and 43 percent of the spinal cord injury patients. Median pressure rises after right-sided and left-sided stimulation were 5 (range, 3-12) and 5 (range, 3-5) mmHg.

CONCLUSIONS

Magnetic sacral root stimulation produces an increase in anal and rectal pressure and a decrease in rectal volume in healthy subjects and patients with fecal incontinence or a spinal cord injury.

Comparative study of the effects of magnetic versus electrical stimulation on inhibition of detrusor overactivity

OBJECTIVES

To perform a randomized comparative study investigating the urodynamic effects of functional magnetic stimulation (FMS) and functional electrical stimulation (FES) on the inhibition of detrusor overactivity.

METHODS

Thirty-two patients with urinary incontinence due to detrusor overactivity (15 men, 17 women; age 62. 3 +/- 16.6 years) were randomly assigned to two treatment groups (15 patients in the FMS group and 17 in the FES group). Stimulation was applied continuously at 10 Hz in both groups. For FMS, the magnetic stimulator unit was set on an armchair type seat and had a concave-shaped coil, so that the patients could sit during stimulation. For FES, a vaginal electrode was used in the women and a surface electrode on the dorsal part of the penis was used in the men. Cystometry was performed before and during the stimulation.

RESULTS

The bladder capacity at the first desire to void and the maximum cystometric capacity increased significantly during stimulation compared with prestimulation levels in both groups (P = 0.0054 and 0.0026, respectively, in the FMS group and P = 0.0015 and 0.0229, respectively, in the FES group). However, the increase in the maximum cystometric capacity was significantly (P = 0.0135) greater in the FMS group (114.2 +/- 124.1 mL or an increase of 105. 5% +/- 130.4% compared with the pretreatment level) than that in the FES group (32.3 +/- 56.6 mL or an increase of 16.3% +/- 33.9%). Detrusor overactivity was abolished in 3 patients in the FMS group but not in any patient in the FES group.

CONCLUSIONS

Although both treatments were effective, the inhibition of detrusor overactivity appeared greater in the FMS group than in the FES group.

Electromagnetic pelvic floor stimulation: applications for the gynecologist

The therapeutic potential of magnetic energy has been a subject of long-standing interest within both conventional and alternative medical practice. Numerous devices using magnetic fields, ranging from the dubious to truly innovative, have claimed a wide variety of clinical benefits. For gynecologists involved with the diagnosis and treatment of pelvic floor and bladder dysfunction, magnetic stimulation of the sacral nerve roots and peripheral nerves continues to evolve as a noninvasive treatment alternative. The conduction characteristics of magnetic energy confer several practical advantages for its use. This article reviews the use of electromagnetic stimulation for treatment of common urogynecologic conditions, and provides an historical overview of the therapeutic application of electromagnetic energy.