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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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Lee UJ, MacDiarmid S, Matthews CA, Gillespie E, Peters KM. Tibial Nerve Stimulation for Urge Urinary Incontinence and Overactive Bladder: Narrative Review of Randomized Controlled Trials and Applicability to Implantable Devices. Adv Ther 2024; 41:2635-2654. [PMID: 38748331 DOI: 10.1007/s12325-024-02864-3] [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: 01/26/2024] [Accepted: 04/01/2024] [Indexed: 06/29/2024]
Abstract
The tibial nerve is an established target for neuromodulation in the management of overactive bladder (OAB) and its associated symptoms, including urge urinary incontinence (UUI). Technologies are currently available to deliver tibial nerve stimulation (TNS) through percutaneous devices or through implantable devices. The benefits and safety of percutaneous TNS have led to it as a guideline-recommended therapy. However, patient compliance is limited by the burden of weekly office visits and the need for maintenance treatments. Further, insurance often only covers a limited number of lifetime visits for percutaneous TNS. These factors and others have led to the development, study, and utilization of implantable TNS devices. Implantable TNS devices deliver the same therapeutic mechanism of action for nerve stimulation with a permanent implanted device that provides at-home stimulation rather than in-office therapy delivery. Additionally, there is an added potential for dynamic and patient-centered stimulation. There is a large body of high-quality evidence published for TNS, including numerous randomized controlled trials published on percutaneous TNS which have consistently demonstrated superior efficacy to sham and similar efficacy to that of anticholinergic medications. Percutaneous TNS also performs better than conservative therapy including pelvic floor muscle training. The percutaneous and implantable approaches deliver nerve stimulation to the same target nerve, using the same mechanism of action. Therefore, data from randomized trials of percutaneous TNS are informative for implantable TNS devices. At the time of this article's publication, at least two implantable TNS devices have received marketing authorization from the Food and Drug Administration (FDA). The objective of this review is to discuss the mechanism of action for TNS and summarize the published literature from clinical trials of percutaneous TNS as a foundation of high-quality evidence for implantable devices targeting the tibial nerve.
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Affiliation(s)
- Una J Lee
- Virginia Mason Medical Center, 1100 Ninth Ave C7-URO, Seattle, WA, 98101, USA.
| | | | | | | | - Kenneth M Peters
- Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
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Huang J, Fan Y, Wang D, Deng Q, Zou X, Yu J. Efficacy and safety of vaginal electrical stimulation as an alternative or adjunct treatment for overactive bladder syndrome in women: a meta-analysis of randomized controlled trials. Int Urogynecol J 2023; 34:2345-2357. [PMID: 37368020 DOI: 10.1007/s00192-023-05546-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/08/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the efficacy and safety of vaginal electrical stimulation (VES) as an alternative or adjunct treatment for overactive bladder (OAB) syndrome in women. METHODS Five English-language databases and four Chinese-language databases were searched to identify relevant studies. Studies comparing VES (VES alone or VES plus other interventions) with other interventions (medicines, bladder training, or PFMT) were included. Voiding diary, quality of life (QoL), and adverse events were extracted from the included studies for comparison. RESULTS Seven trials with 601 patients in total were reviewed. The results showed that when compared with other interventions, VES alone significantly improved urgency episodes (p = 0.0008) and voiding frequency (p = 0.01), but did not significantly reduce nocturia (p = 0.85), urinary incontinence episodes (p = 0.90) and number of pads (p = 0.87). When VES plus other interventions was compared with other interventions, the former significantly improved voiding frequency (p < 0.00001), nocturia (p < 0.00001), and number of pads (p = 0.03), but it did not significantly reduce urinary incontinence episodes (p = 0.24). Both VES alone (p < 0.00001) and VES plus other interventions (p = 0.003) showed significant benefit on QoL. CONCLUSIONS This study demonstrated that VES alone decreased urgency episodes and QoL better than other therapies. Although VES alone reduced voiding frequency better and VES plus other therapies decreased nocturia, number of pads, urgency episodes, and QoL better than other therapies, the results should be interpreted with caution for clinical practice because some of the RCTs included were of low quality and because of the small number of studies included.
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Affiliation(s)
- Jiapeng Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ye Fan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Dexin Wang
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Qiuying Deng
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Xu Zou
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
| | - Jin Yu
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
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Yildiz N, Unal B. Comparison of the efficacy of intravaginal electrical stimulation in women with idiopathic overactive bladder naive and refractory to pharmacological agents. Int Urogynecol J 2023; 34:2099-2105. [PMID: 36976326 DOI: 10.1007/s00192-023-05517-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study aims to compare the effectiveness of intravaginal electrical stimulation (IVES) with regard to quality of life (QoL) and clinical parameters related to incontinence in women with idiopathic overactive bladder (iOAB) naive or refractory to treatment with pharmacological agents (PhA). METHODS In this prospective trial, PhA-naive women were included in Group 1 (n = 24) and women with PhA-resistant iOAB were included in Group 2 (n = 24). IVES was performed 3 days a week, with a total of 24 sessions for 8 weeks. Every session lasted 20 minutes. Women were evaluated for the severity of incontinence (24-hour pad test), pelvic floor muscle (PFM) strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and the number of pads), symptom severity (OAB-V8), quality of life (IIQ-7), treatment success (positive response rate), cure/improvement rate, and treatment satisfaction. RESULTS A statistically significant improvement was found in all parameters for each group at the 8th week compared to the baseline values (p < 0.05). At the 8th week, there were no statistically significant differences in the severity of incontinence, PFM strength, incontinence episodes, nocturia, number of pads, QoL, treatment satisfaction, cure-improvement, or positive response rates between the two groups (p > 0.05). It was found that the frequency of voiding and symptom severity parameters were significantly more improved in Group 1 than in Group 2 (p < 0.05). CONCLUSIONS Although IVES was more effective in PhA-naive women with iOAB, it also appears to be an effective treatment in the management of women with PhA-resistant iOAB. CLINICAL TRIAL REGISTRATION This study was registered with ClinicalTrials.gov under no. NCT05416450.
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Affiliation(s)
- Necmettin Yildiz
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey.
- Pamukkale Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, 20100 Kınıklı, Denizli, Turkey.
| | - Burak Unal
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Álvarez DMC, Serrano-Muñoz D, Fernández-Pérez JJ, Moreno JS, Gómez-Soriano J, Avendaño-Coy J. The effect on handgrip strength of low-frequency percutaneous electric stimulation applied to the median and cubital nerves: A randomized, double-blind controlled trial. Anat Rec (Hoboken) 2023; 306:720-727. [PMID: 35166034 DOI: 10.1002/ar.24887] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/17/2021] [Accepted: 01/10/2022] [Indexed: 11/12/2022]
Abstract
Percutaneous electrical nerve stimulation (PENS) consists of applying an electric current of <1,000 Hz to different neuromuscular structures through acupuncture needles. Currently, there is controversy surrounding the effect of PENS on muscle strength in the scientific literature. The main objective was to assess the effect of PENS applied to the median and cubital nerves on the maximum handgrip strength (MHS) compared to sham stimulation, as well as to determine the safety of the intervention. A parallel, randomized, double-blind controlled trial in a sample of 20 healthy subjects. Participants were randomly allocated in the experimental (n = 10) and control (n = 10) groups. A blinded researcher measured MHS. Measurements of MHS of the dominant hand were taken at four time points: preintervention, immediately postintervention, 24 hr after the intervention, and at a 10-day follow-up. A 10-Hz percutaneous electrical current stimulation was employed. The control group also received the same puncture method but with no electric stimulation. Compared to baseline, the MHS decreased 10.4% (SEM = 3.2, p = .02) in the PENS group at 24 hr postintervention, with no differences observed between baseline and at 10 days postintervention. No changes in grip strength were observed at any time point in the sham group. To sum up, PENS decreased MHS at 24 hr postintervention, which does not persist 10 days after the stimulation. PENS can be considered a safe technique. Trials with larger sample sizes are required to corroborate the findings of this study. Clinical Trials Registration: NCT, NCT04662229, filed on March 12th of 2020.
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Affiliation(s)
- David Martín-Caro Álvarez
- Faculty of Physiotherapy and Nursing of Toledo, Toledo Physiotherapy Research Group (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
| | - Diego Serrano-Muñoz
- Faculty of Physiotherapy and Nursing of Toledo, Toledo Physiotherapy Research Group (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
| | - Juan José Fernández-Pérez
- Faculty of Physiotherapy and Nursing of Toledo, Toledo Physiotherapy Research Group (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
| | - Jaime Salom Moreno
- Faculty of Physiotherapy and Nursing of Toledo, Toledo Physiotherapy Research Group (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
| | - Julio Gómez-Soriano
- Faculty of Physiotherapy and Nursing of Toledo, Toledo Physiotherapy Research Group (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
| | - Juan Avendaño-Coy
- Faculty of Physiotherapy and Nursing of Toledo, Toledo Physiotherapy Research Group (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
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Wang H, Lei X. Acupuncture for Women with Overactive Bladder: Perspective of Traditional Chinese Medicine and Related Mechanism. Int J Gen Med 2023; 16:1137-1148. [PMID: 37013136 PMCID: PMC10066631 DOI: 10.2147/ijgm.s406194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose Overactive bladder (OAB) syndrome is one of the most common diseases in urology and affects quality of life. Although the current treatment for OAB is based on oral medications, there are limitations and many patients have difficulty accepting drug-induced adverse effects. This review aimed to analyze the efficacy of acupuncture and its related mechanisms and provide a preliminary therapeutic regimen. Methods Two authors independently searched PubMed, Embase, and Cochrane Library up to April 2022. They searched related English literature and extracted the data under a standard form based on the search strategy. Clinical trials which included OAB women with the treatment of acupuncture were included. Common acupuncture alone without other pharmacotherapy, external treatments was in the treatment group. The control interventions may include any active treatments, sham placebo, or no establishment of a control group. Outcomes included 3-day or 24-hour voiding diary, overactive bladder symptom score, etc. The Cochrane risk of bias tool was also used to assess the methodological quality of the randomized controlled trials (RCTs). Results We analyzed five RCTs and one comparative study on acupuncture for OAB to review and discuss the acupoint location, treatment course, and retention time based on clinical evidence and treatment ideas in traditional Chinese medicine. Additionally, we used the available evidence to reveal and discuss the acupuncture mechanisms for OAB. Acupuncture may regulate bladder function by inhibiting C-fibers, modulating nerve growth factors and reducing spontaneous contractions of the detrusor muscle. Conclusion Combined with the available evidence, the combination of local acupoints and distal acupoints should be necessary to consider, especially the lumbosacral acupoints, the small abdomen acupoints and the lower limb acupoints. Among them, acupuncture at SP4, CV4 and KI3 are strongly recommended. The treatment course of acupuncture should be no less than 4 weeks and maintain the frequency of acupuncture no less than once a week. The duration of each session should be no less than 20 minutes. In addition, investigations remain necessary to verify acupuncture's efficacy and precise mechanism for OAB treatment in further exploration.
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Affiliation(s)
- Hao Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Xulu Lei
- Department of Preventive Care Center, Beijing Fengtai Hospital of Integrated Chinese and Western Medicine, Beijing, People’s Republic of China
- Correspondence: Xulu Lei, Department of Preventive Care Center, Beijing Fengtai Hospital of Integrated Chinese and Western Medicine, Beijing, 100072, People’s Republic of China, Email
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Bai J, Tian Y, Wang Y, Zhang X, Wang P. Physical and Rehabilitation Therapy for Overactive Bladder in Women: A Systematic Review and Meta-Analysis. Int J Clin Pract 2023; 2023:6758454. [PMID: 36704247 PMCID: PMC9833926 DOI: 10.1155/2023/6758454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To compare the effects of different physical and rehabilitation therapies on women with overactive bladder (OAB). DESIGN Network meta-analysis. Data source: The Embase, Scopus, and PubMed databases were systematically searched from their inception to June 22, 2022. We included only RCTs, with no language restrictions. Articles in the reference lists and related studies were thoroughly reviewed. Review Methods. This network meta-analysis included related studies on different physical and rehabilitation therapies for OAB. Data were extracted independently from the included randomized controlled trials by two authors, and they used the Cochrane Collaboration's tool to evaluate the risk of bias. We used RevMan to assess the risk assessment of research bias. This network meta-analysis was performed using the Stata software. We completed the review in accordance with the PRISMA items for systematic reviews and meta-analyses statement. RESULTS Twelve randomized controlled trials involving 637 patients were included in this meta-analysis. All physical and rehabilitation therapies improved daytime micturition frequency and nocturia frequency in OAB patients. Percutaneous tibial nerve stimulation (PTNS), BT + ES, and BT + BF + ES are better interventions for OAB treatment. There were no significant differences in PTNS, BT + ES, and BT + BF + ES. CONCLUSION All physical and rehabilitation therapies can improve daytime micturition and nocturia frequency in OAB. PTNS, BT + ES, and BT + BF + ES were the priority therapies.
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Affiliation(s)
- Jingwen Bai
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Yilan Tian
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
| | - Yiran Wang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
| | - Xiaofang Zhang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
| | - Ping Wang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
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The association between recent cannabis use and urinary incontinence in women: a population-based analysis of the NHANES from 2009 to 2018. World J Urol 2022; 40:3099-3105. [DOI: 10.1007/s00345-022-04193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/06/2022] [Indexed: 10/31/2022] Open
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Yao H, Zhang X, Sun F, Tang G, Wu J, Zhou Z. The efficacy of intravaginal electrical stimulation (IVES) in treating female with urinary incontinence symptom from meta-analysis of nine randomized controlled trials. Front Neurol 2022; 13:933679. [PMID: 36176556 PMCID: PMC9514856 DOI: 10.3389/fneur.2022.933679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundUrinary incontinence (UI) is a common disease in the middle-aged and elderly women, and physical therapy has gradually become the mainstream treatment of UI. We conducted a meta-analysis to evaluate the efficacy of intravaginal electrical stimulation (IVES) in the treatment of UI.MethodsFrom January 2006 to December 2021, we finally selected nine randomized controlled trials (RCTs) including 657 participants from PubMed, EMBASE, and Cochrane databases to evaluate the efficacy of IVES in the treatment of female UI. Continuous data were represented by mean difference and 95% CI, while dichotomous data were represented by odds ratio and 95% CI. All the data were analyzed by the Review Manager Version 5.4.ResultsCompared with the control group, there were significant improvements in urine pad test (P = 0.01), urinary incontinence frequency (P = 0.04), some indicators in the incontinence quality of life questionnaire and King's health questionnaires, and subjective feeling of cure (P = 0.009) in the IVES group. However, in other indicators reflecting UI, there was no significant difference between the IVES group and the control group. In addition, subgroup analysis showed that IVES and IVES combined with training could significantly reduce the weight of the urine pad, which reflected the improvement of urine leakage.ConclusionThis meta-analysis proved that IVES can partially improve the symptoms of female patients with UI compared with the control group. However, it still needs to be further evaluated through more high-quality research in the future.
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Affiliation(s)
- Huibao Yao
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaofei Zhang
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Fengze Sun
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Gonglin Tang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Jitao Wu
| | - Zhongbao Zhou
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhongbao Zhou
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Effects of transcutaneous tibial nerve stimulation on females with overactive bladder syndrome in multiple sclerosis a protocol for a systematic review and meta-analysis. PLoS One 2022; 17:e0269371. [PMID: 35901036 PMCID: PMC9333199 DOI: 10.1371/journal.pone.0269371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/17/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Overactive bladder (OAB) is a problem that increasingly affects adults and the elderly, especially women. It may affect quality of life, ability to participate and overall wellbeing. Transcutaneous tibial nerve stimulation (TTNS) is a form of neuromodulation involving the use of electrical impulses to address urinary symptoms. There are many randomized controlled trials that have shown that TTNS is effective at treating overactive bladder. In recent years, TTNS has gained increasing attention for this condition. But its effect in females remains controversial and evidence is lacking. Therefore, the main purpose of this study will be to systematically evaluate the effect of TTNS on females with OAB in Multiple sclerosis (MS) by conducting a systematic review and meta-analysis, and also to provide a reference for the application of TTNS in OAB.
Methods
A systematic review of eligible articles will be conducted using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive search of the literature will be conducted in PubMed, Web of Science, The Cochrane Library, Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Data, Weipu Electronics, and other databases. We will include randomized controlled trials about TTNS in females with OAB in MS. Two reviewers will screen titles, abstracts, and full texts independently. We will use a hierarchy of recommended assessment, development, and assessment methods to assess the overall certainty of the evidence and report findings accordingly. Endnote X9 will be used to select the studies and Review Manager V.5.4 (Cochrane Collaboration) will be used to conduct the meta-analysis. The mean difference or standard deviation with 95% confidence interval (CI) will be used in the computation of continuous variables to synthesize data.
Results
The results will provide evidence for judging whether TTNS is effective in females with OAB and MS.
Conclusion
This study will provide reliable evidence for the effect of TTNS in female patients with OAB and MS.
Trial registration
Systematic review registration: PROSPERO CRD42021256861.
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Yildiz N, Alkan H, Findikoglu G. Efficacy of intravaginal electrical stimulation with different treatment frequency in women with refractory idiopathic overactive bladder. Int Braz J Urol 2022; 48:662-671. [PMID: 35363455 PMCID: PMC9306357 DOI: 10.1590/s1677-5538.ibju.2021.0837] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this study is to evaluate the effect of intravaginal electrical stimulation (IVES) therapies with different treatment frequencies (two or five days in a week) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with refractory idiopathic overactive bladder (OAB). Material and Methods Fifty-two women with refractory idiopathic OAB were randomized into two groups as follows: Group 1 (n:26) received BT and IVES, two times in a week, for 10 weeks and Group 2 (n:26) received BT and IVES five times in a week, for 4 weeks. IVES was performed 20 minutes in a day, a total of 20 sessions for both groups. Women were evaluated for incontinence severity (24h pad test), pelvic floor muscles strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and the number of pads), symptom severity (OAB-V8), quality of life (IIQ-7), treatment success (positive response rate), cure/improvement rate and treatment satisfaction (Likert scale). Results There was no statistically significant differences in all parameters between the two groups at the end of the treatment. It was found that the treatment satisfaction scores, cure/improvement and positive response rates were not significantly different between two groups (p>0.05). Conclusion We concluded that the application of IVES twice a week or 5 times a week added to BT were both effective on incontinence-related QoL and clinical parameters in women with refractory idiopathic OAB. These two IVES frequencies had similar clinical efficacy and patient satisfaction with a slight difference between them; 5 times per week IVES has a shorter treatment duration.
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Affiliation(s)
- Necmettin Yildiz
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Hakan Alkan
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Gulin Findikoglu
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Yildiz N. Re: Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study. Int Braz J Urol 2022; 48:732-733. [PMID: 35503705 PMCID: PMC9306369 DOI: 10.1590/s1677-5538.ibju.2022.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Necmettin Yildiz
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
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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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Astasio-Picado Á, García-Cano M. Neuromodulation of the Posterior Tibial Nerve for the Control of Urinary Incontinence. Medicina (B Aires) 2022; 58:medicina58030442. [PMID: 35334618 PMCID: PMC8955811 DOI: 10.3390/medicina58030442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/01/2022] Open
Abstract
Urinary incontinence is considered a health problem that both elderly and young people can suffer, most often elderly women. This problem can lead to difficulties in establishing social relationships and dependence, negatively affecting the quality of life of the people who suffer from it. To evaluate and analyze the studies that demonstrate the efficacy of interventions based on the neuromodulation of the posterior tibial nerve as a treatment for the control of urinary incontinence. The search period for articles focused on those published between March 2011 to March 2021, in five databases (Pubmed, Cochrane Library, Scielo, Google Academic and WOS) based on the clinical question, using the keywords derived from the DeCS and MeSH thesauri, combined with the Boolean operators “AND”, “NOT” and “OR”. The search was limited to publications from the last 10 years, in English and Spanish. After applying the selection criteria and evaluating the quality of the methodology, 5.28% (n = 27) of the 511 results were included with filters: 9 systematic reviews, 10 cohorts and 8 randomized controlled trials. After comparing the different articles, it was found that percutaneous stimulation of the tibial nerve is a suitable technique for treating overactive bladder. It is a promising technique in case of pelvic floor dysfunctions and effective for the control of urinary incontinence.
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The effectiveness of different electrical nerve stimulation protocols for treating adults with non-neurogenic overactive bladder: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:1045-1058. [PMID: 35119495 DOI: 10.1007/s00192-022-05088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Electrical nerve stimulation is a widely used treatment for overactive bladder but there is no consensus regarding the best placement of electrodes or protocols. We hypothesised that some non-implanted neurostimulation protocols would be more effective compared to others for treating urinary symptoms and improving quality of life among adults diagnosed with non-neurogenic overactive bladder. METHODS A systematic review and meta-analyses of randomized clinical trials were performed in five electronic databases: PubMed/MEDLINE, Lilacs, CINAHL, Web of Science, and PEDro. The main outcome was urinary symptoms-frequency, nocturia, and urgency-and the secondary outcome quality of life. Some protocol characteristics were extracted, e.g., frequency, pulse width, intensity, intervention time, and electrode placement. RESULTS Nine randomized controlled trials were included. Tibial neurostimulation showed better results than sacral neurostimulation for urge incontinence (mean difference = 1.25 episodes, 95% CI, 0.12-2.38, n = 73). On the pooled analysis, the different neurostimulation protocols-intravaginal, percutaneous tibial, and transcutaneous tibial nerve stimulation-demonstrated similar results for urinary frequency, nocturia, and urgency as well as quality of life. In general, effect sizes from meta-analyses were low to moderate. The best reported parameters for percutaneous tibial nerve stimulation were 20-Hz frequency and 200-μs width, once a week. CONCLUSIONS There was evidence that tibial neurostimulation is more effective than sacral neurostimulation for urge incontinence symptoms among patients with non-neurogenic overactive bladder. Overall, there was no superiority of an electrical nerve stimulation electrode placement and protocol over others considering urinary symptoms and quality of life. Further studies with three-arm trials are necessary. This study was registered at PROSPERO: CRD4201810071.
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Riccetto CLZ. Intravaginal eletrical stimulation for bladder training method. Int Braz J Urol 2021; 47:1160-1161. [PMID: 34469669 PMCID: PMC8486461 DOI: 10.1590/s1677-5538.ibju.2021.0161.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/15/2021] [Indexed: 01/01/2023] Open
Affiliation(s)
- Cassio L Z Riccetto
- Divisão de Urologia Feminina - Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
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Shi C, Zhou D, Yu W, Jiao W, Shi G, Wang Y. Efficacy of Yun-Type Optimized Pelvic Floor Training Therapy for Middle-Aged Women With Severe Overactive Bladder: A Randomized Clinical Trial. Front Surg 2021; 8:670123. [PMID: 34336915 PMCID: PMC8316598 DOI: 10.3389/fsurg.2021.670123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022] Open
Abstract
Background: This study aimed to evaluate the clinical efficacy of Yun-type optimized pelvic floor training therapy for middle-aged women with severe overactive bladder (OAB). Methods: This randomized, observer-blinded, parallel-group controlled clinical trial included 108 middle-age women with severe OAB and assigned them to the intervention group (treated with combination of Yun-type optimized pelvic floor training with solifenacin for 12 weeks) and control group (treated with solifenacin for 6 weeks and, after 2 weeks of elution, received the combination of Yun-type optimized pelvic floor training and solifenacin for 6 weeks). The outcomes associated with OAB, pelvic floor muscle (PFM) function, and sexual function were compared after 6 and 12/14 weeks of treatment. Results: The primary variables were OAB-associated outcomes, including overactive bladder symptom score (OABSS), urgent urination, urine, nocturia, urge urinary incontinence, patient's perception of bladder condition, urogenital distress inventory-6, incontinence impact questionnaire-7, voiding volume, average flow rate, and maximum flow rate. The secondary variables were indicators related to PFM function and sexual function. These indicators were significantly improved in both groups after interventions. Notably, the improvements in most of these indicators were superior in the intervention group than in the control group after 6 weeks and 12/14 weeks of treatment. Conclusions: The use of Yun-type optimized pelvic floor training adds to the benefits of solifenacin regarding severe OAB-associated outcomes, PMF function, and sexual function in middle-aged women with severe OAB. Combining Yun-type optimized pelvic floor training with traditional drug therapies may improve clinical outcomes in patients with severe OAB. Trial Registration: ChiCTR-INR-17012189.
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Affiliation(s)
- Chaoliang Shi
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Dan Zhou
- School of Health and Social Care, Shanghai Urban Construction Vocational College, Shanghai, China
| | - Wandong Yu
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wei Jiao
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Guowei Shi
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yangyun Wang
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
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Agost-González A, Escobio-Prieto I, Pareja-Leal AM, Casuso-Holgado MJ, Blanco-Diaz M, Albornoz-Cabello M. Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9070879. [PMID: 34356261 PMCID: PMC8306496 DOI: 10.3390/healthcare9070879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Percutaneous electrical stimulation and transcutaneous electrical stimulation (PTNS and TTNS) of the posterior tibial nerve are internationally recognized treatment methods that offer advantages in terms of treating patients with overactive bladder (OAB) who present with urinary incontinence (UI). This article aims to analyze the scientific evidence for the treatment of OAB with UI in adults using PTNS versus TTNS procedures in the posterior tibial nerve. METHODS A systematic review was conducted, between February and May 2021 in the Web of Science and Scopus databases, in accordance with the PRISMA recommendations. RESULTS The research identified 259 studies, 130 of which were selected and analyzed, with only 19 used according to the inclusion requirements established. The greatest effectiveness, in reducing UI and in other parameters of daily voiding and quality of life, was obtained by combining both techniques with other treatments, pharmacological treatments, or exercise. CONCLUSIONS TTNS has advantages over PTNS as it is more comfortable for the patient even though there is equality of both therapies in the outcome variables. More research studies are necessary in order to obtain clear scientific evidence.
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Affiliation(s)
- Aida Agost-González
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (A.A.-G.); (M.J.C.-H.); (M.A.-C.)
| | - Isabel Escobio-Prieto
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (A.A.-G.); (M.J.C.-H.); (M.A.-C.)
- Correspondence:
| | | | - María Jesús Casuso-Holgado
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (A.A.-G.); (M.J.C.-H.); (M.A.-C.)
| | - María Blanco-Diaz
- Departamento de Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, 33006 Oviedo, Spain;
| | - Manuel Albornoz-Cabello
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (A.A.-G.); (M.J.C.-H.); (M.A.-C.)
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Celenay ST, Karaaslan Y, Coban O, Oskay K. A comparison of Kinesio taping and external electrical stimulation in addition to pelvic floor muscle exercise and sole pelvic floor muscle exercise in women with overactive bladder: a randomized controlled study. Disabil Rehabil 2021; 44:5124-5132. [PMID: 34098818 DOI: 10.1080/09638288.2021.1925751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the effects of Kinesio taping® (KT) and external electrical stimulation (ES) in addition to pelvic floor muscle exercise (PFME) and sole PFME in women with overactive bladder (OAB). MATERIAL AND METHODS Patients with OAB were randomly allocated into PFME, PFME + KT, PFME + ES groups. All treatments were carried out for 6 weeks. OAB symptoms with voiding diary and Overactive Bladder-Version8 (OAB-V8), pelvic floor muscle strength (PFMS) with perineometer, quality of life with King's Health Questionnaire (KHQ) were assessed before (BT) and after treatment (AT). AT, the perception of improvement was inquired. RESULTS AT, OAB symptoms and KHQ scores decreased and PFMS improved in all groups (p < 0.05). The intergroup comparisons revealed a further decrease in voids/day, voids/night, OAB-V8, and some KHQ scores, and a further increase in the perception of improvement in the PFME + KT and PFME + ES groups compared to the PFME group (p < 0.05). In the PFME + ES group, there was a further decrease in numbers of incontinence compared to the PFME group, and in severity measures scores compared to the other groups (p < 0.05). CONCLUSION KT and external ES in addition to PFME were more effective than PFME alone in the treatment of OAB.IMPLICATIONS FOR REHABILITATIONPelvic floor muscle exercise was found to be effective in reducing overactive bladder symptoms and increasing quality of life.Kinesio taping or external electrical stimulation in addition to pelvic floor muscle exercise is more effective in improving overactive bladder symptoms, quality of life, and perception of improvement than pelvic floor muscle exercise alone.Kinesio taping and external electrical stimulation can be used as a complementary application in the treatment of overactive bladder.Pelvic floor muscle exercise, pelvic floor muscle exercise + Kinesio taping, and pelvic floor muscle exercise + electrical stimulation applications should be included in conservative treatment options in patients with overactive bladder to reduce symptoms and cost, and improve quality of life.
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Affiliation(s)
- Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Ankara Yildirim Beyazit University Ankara, Ankara, Turkey
| | - Yasemin Karaaslan
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Beykent University, Istanbul, Turkey
| | - Ozge Coban
- Faculty of Gulhane Physiotherapy and Rehabilitation, Health Science University, Ankara, Turkey
| | - Kemal Oskay
- Department of Urology, Ankara Gazi Mustafa Kemal Hospital, Ankara, Turkey
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Randomized clinical trials assessing third-line therapies to treat non-neurogenic overactive bladder syndrome: a review about methodology. Int Urogynecol J 2021; 32:2603-2618. [PMID: 33770228 DOI: 10.1007/s00192-021-04688-z] [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: 11/14/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Using similar methodologies and outcome measures is crucial to allow pertinent literature reviews and meta-analyses. Therefore, this scoping review aims to compare methodologies of randomized clinical trials (RCTs) assessing the efficacy of third-line therapies to treat non-neurogenic OAB: intradetrusor onabotulinumtoxinA (BoNTA) injections, sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS). METHODS A literature search was conducted using the PubMed search database. Using filters, the search was limited to RCTs conducted on humans and written in English or French since 2000 which evaluated BoNTA injections, SNM and/or PTNS. RCTs focusing on pediatric or neurogenic OAB were excluded. For each included RCT, methodology was assessed using a standardized form investigating the study design, clinical outcomes and urodynamic outcomes. Inclusion criteria, sex ratio, blinding strategies, treatment arms, primary outcomes and delays for reevaluation were assessed. Availability of clinical and urodynamic outcomes was reported at baseline, 3 months and 6 months. RESULTS Thirty-one RCTs were included in the final synthesis. The most frequent main outcome measure was change in the number of urinary incontinence episodes in 35.5% and in the number of voids per day in 25.8%. Bladder diaries were lacking in 12.9%, 32.3% and 80.1% at baseline, 3 and 6 months, respectively, while 26% of studies reported the results of urodynamic studies at any point. CONCLUSION Heterogeneity in study designs and data collection was pointed out between RCTs assessing the efficacy of third-line therapies to treat non-neurogenic OAB. We therefore advocate for the development of specific research guidelines focusing on OAB-related therapies.
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21
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Yang SJ, Park JH, Oh Y, Kim H, Kong M, Moon J. Association of decreased grip strength with lower urinary tract symptoms in women: a cross-sectional study from Korea. BMC Womens Health 2021; 21:96. [PMID: 33663465 PMCID: PMC7934376 DOI: 10.1186/s12905-021-01241-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) including frequency, nocturia, urgency, and incontinence, are common in women and cause significant discomfort in daily life. However, diagnosis and treatment of LUTS are often delayed because many patients with such symptoms do not complain to the physician of discomfort and do not seek medical attention. LUTS are known to be associated with muscle weakness. We investigated the association between grip strength and LUTS in women of different ages. METHODS This study included 4225 women (mean age 48.6 years) who underwent self-referred health screening between April 2015 and December 2019. LUTS were evaluated using a self-reported questionnaire, and the overactive bladder symptom score was used to screen for an overactive bladder. Low muscle strength was defined as a hand grip strength of < 18 kg (decreased grip strength). RESULTS We observed decreased grip strength in 13.7% (n = 580) of the participants. Nocturia, urgency, incontinence, and overactive bladder were more common in women with decreased grip strength than in women with normal grip strength. After adjusting for age, comorbidities (hypertension, diabetes, hyperlipidemia), smoking status, alcohol consumption, regular exercise, and stress, nocturia (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.01-1.52), urinary incontinence (OR 1.32, 95% CI 1.01-1.72), and an overactive bladder (OR 1.75, 95% CI 1.35-2.27) were significantly associated with decreased grip strength. CONCLUSIONS The findings suggest that LUTS, especially nocturia, incontinence, and an overactive bladder are associated with decreased grip strength in women. Therefore, physicians should be aware that patients may not seek help, even if they are uncomfortable, and it is important to obtain a detailed medical history and perform additional tests, even in the absence of complaints, in patients with low grip strength, who are at high risk of LUTS.
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Affiliation(s)
- Su-Jin Yang
- School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Jung Ha Park
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea
| | - Yunhwan Oh
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Hyeonju Kim
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Mihee Kong
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Jihyun Moon
- Department of Family Medicine, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju, 690-767, Republic of Korea.
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea.
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22
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Wang M, Jian Z, Ma Y, Jin X, Li H, Wang K. Percutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis. Int Urogynecol J 2020; 31:2457-2471. [DOI: 10.1007/s00192-020-04429-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/01/2020] [Indexed: 01/16/2023]
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Comparing the Efficacy of OnabotulinumtoxinA, Sacral Neuromodulation, and Peripheral Tibial Nerve Stimulation as Third Line Treatment for the Management of Overactive Bladder Symptoms in Adults: Systematic Review and Network Meta-Analysis. Toxins (Basel) 2020; 12:toxins12020128. [PMID: 32085542 PMCID: PMC7077313 DOI: 10.3390/toxins12020128] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/29/2022] Open
Abstract
The American Urological Association guidelines for the management of non-neurogenic overactive bladder (OAB) recommend the use of OnabotulinumtoxinA, sacral neuromodulation (SNM), and peripheral tibial nerve stimulation (PTNS) as third line treatment options with no treatment hierarchy. The current study used network meta-analysis to compare the efficacy of these three modalities for managing adult OAB syndrome. We performed systematic literature searches of several databases from January 1995 to September 2019 with language restricted to English. All randomized control trials that compared any dose of OnabotulinumtoxinA, SNM, and PTNS with each other or a placebo for the management of adult OAB were included in the study. Overall, 17 randomized control trials, with a follow up of 3–6 months in the predominance of trials (range 1.5–24 months), were included for analysis. For each trial outcome, the results were reported as an average number of episodes of the outcome at baseline. Compared with the placebo, all three treatments were more efficacious for the selected outcome parameters. OnabotulinumtoxinA resulted in a higher number of complications, including urinary tract infection and urine retention. Compared with OnabotulinumtoxinA and PTNS, SNM resulted in the greatest reduction in urinary incontinence episodes and voiding frequency. However, comparison of their long-term efficacy was lacking. Further studies on the long-term effectiveness of the three treatment options, with standardized questionnaires and parameters are warranted.
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Jacomo RH, Alves AT, Lucio A, Garcia PA, Lorena DCR, de Sousa JB. Transcutaneous tibial nerve stimulation versus parasacral stimulation in the treatment of overactive bladder in elderly people: a triple-blinded randomized controlled trial. Clinics (Sao Paulo) 2020; 75:e1477. [PMID: 31939564 PMCID: PMC6943254 DOI: 10.6061/clinics/2020/e1477] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the effect of transcutaneous tibial nerve stimulation (TTNS) and transcutaneous parasacral stimulation on the treatment of overactive bladder (OAB) in elderly people and to compare the final results between groups. METHODS Fifty female volunteers, mean age 68.62 (±5.9) years, were randomly allocated into two groups: those receiving TTNS (G1, N=25) and those receiving transcutaneous parasacral stimulation (G2, N=25). The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ-OAB) score, and secondary outcomes were the International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) score and 3-day bladder diary measurements. Volunteers were assessed before and after the treatment. Clinical Trials (ReBeC): RBR-9Q7J7Y. RESULTS Both groups' symptoms improved as measured by the ICIQ-OAB (G1 = <0.001; G2 = <0.001) and ICIQ-SF (G1 = <0.001; G2 = <0.001). In the 3-day bladder diary assessments after treatment, G1 showed a reduced number of nocturia (p<0.001), urgency (p<0.001) and urge urinary incontinence episodes (p<0.001), whereas G2 showed only a reduced number of nocturia episodes (p<0.001). No difference between groups was found. CONCLUSION Both of the proposed treatments were effective in the improvement of OAB symptoms, but TTNS showed a reduction in a greater number of symptoms as measured by the 3-day bladder diary. No differences were found between groups.
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Affiliation(s)
- Raquel Henriques Jacomo
- Programa de Ciencias Medicas, Faculdade de Medicina, Universidade de Brasilia, Brasilia, DF, BR
- *Corresponding author. E-mail:
| | - Aline Teixeira Alves
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Departamento de Fisioterapia, Universidade de Brasilia, Brasilia, DF, BR
| | - Adélia Lucio
- Unidade de Reabilitacao, Hospital Universitario, Universidade do Mato Grosso do Sul, Campo Grande, MS, BR
| | - Patrícia Azevedo Garcia
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Departamento de Fisioterapia, Universidade de Brasilia, Brasilia, DF, BR
| | - Dayanne Cristina Ramos Lorena
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Departamento de Fisioterapia, Universidade de Brasilia, Brasilia, DF, BR
| | - João Batista de Sousa
- Programa de Ciencias Medicas, Faculdade de Medicina, Universidade de Brasilia, Brasilia, DF, BR
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Bhide AA, Tailor V, Fernando R, Khullar V, Digesu GA. Posterior tibial nerve stimulation for overactive bladder-techniques and efficacy. Int Urogynecol J 2019; 31:865-870. [PMID: 31853597 PMCID: PMC7210232 DOI: 10.1007/s00192-019-04186-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 11/13/2019] [Indexed: 01/16/2023]
Abstract
The ideal treatment for overactive bladder is still elusive. In those where medication fails to improve symptoms options include invasive treatments such as botulinum toxin-A, sacral neural stimulation or posterior tibial nerve stimulation. Scientific professional society guidelines advise percutaneous posterior tibial nerve stimulation as a third line treatment option only after multi-disciplinary team review as well as failure of both conservative and pharmacological management. The aim of this article is to review all techniques for tibial nerve stimulation and their efficacy.
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Affiliation(s)
- Alka A Bhide
- St Mary's Hospital, Imperial College NHS Trust, London, UK.
| | - Visha Tailor
- St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Ruwan Fernando
- St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Vik Khullar
- St Mary's Hospital, Imperial College NHS Trust, London, UK
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Kasman A, Stave C, Elliott CS. Combination therapy in overactive bladder‐untapped research opportunities: A systematic review of the literature. Neurourol Urodyn 2019; 38:2083-2092. [DOI: 10.1002/nau.24158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/18/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Alex Kasman
- Department of UrologyStanford University School of Medicine Stanford California
| | - Christopher Stave
- Department of UrologyStanford University School of Medicine Stanford California
| | - Christopher S. Elliott
- Department of UrologyStanford University School of Medicine Stanford California
- Division of UrologySanta Clara Valley Medical Center San Jose California
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Boaretto JA, Mesquita CQ, Lima AC, Prearo LC, Girão MJBC, Sartori MGF. Comparação entre oxibutinina, eletroestimulação do nervo tibial posterior e exercícios perineais no tratamento da síndrome da bexiga hiperativa. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17020026022019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivou-se avaliar a eficácia dos exercícios perineais, da eletroestimulação transcutânea do nervo tibial posterior (ETNTP) e da oxibutinina em mulheres com síndrome da bexiga hiperativa, que é a segunda causa mais comum de incontinência urinária, com sintomas urinários extremamente incômodos que prejudicam a qualidade de vida. Foram randomizadas 65 mulheres, das quais 57 completaram o tratamento. Formaram-se três grupos: o de exercícios perineais, ETNTP e o grupo controle, que utilizou oxibutinina. Os exercícios foram realizados em grupo, nas posições em pé, supino e sentado, duas vezes por semana, com duração de 30 minutos cada sessão, totalizando 12 sessões. Na ETNTP utilizou-se eletrodo transcutâneo posicionado em maléolo medial e outro 10cm acima, com frequência de 10Hz e largura de pulso de 200 microssegundos, por 30 minutos, duas vezes por semana, totalizando 12 sessões. Na medicação as pacientes receberam oxibutinina de 10mg/dia de liberação imediata divididos e duas doses de 5mg/dia, durante 12 semanas consecutivas. Antes e depois dos tratamentos, as pacientes passaram por uma avaliação composta pela análise do diário miccional, avaliação funcional do assoalho pélvico e aplicação de questionário de qualidade de vida OAB-V8. Houve redução da incontinência de urgência em 50%, 70,5% e 41% nos grupos de exercício, ETNTP e oxibutinina, respectivamente, com significância estatística somente da eletroestimulação. As três modalidades de tratamento foram eficazes na melhora da qualidade de vida para a terapêutica em curto prazo, estatisticamente semelhantes entre si.
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Recent Non-neurogenic Overactive Bladder Trials. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Detecting Bladder Biomarkers for Closed-Loop Neuromodulation: A Technological Review. Int Neurourol J 2018; 22:228-236. [PMID: 30599493 PMCID: PMC6312967 DOI: 10.5213/inj.1836246.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022] Open
Abstract
Neuromodulation was introduced for patients with poor outcomes from the existing traditional treatment approaches. It is well-established as an alternative, novel treatment option for voiding dysfunction. The current system of neuromodulation uses an open-loop system that only delivers continuous stimulation without considering the patient's state changes. Though the conventional open-loop system has shown positive clinical results, it can cause problems such as decreased efficacy over time due to neural habituation, higher risk of tissue damage, and lower battery life. Therefore, there is a need for a closed-loop system to overcome the disadvantages of existing systems. The closed-loop neuromodulation includes a system to monitor and stimulate micturition reflex pathways from the lower urinary tract, as well as the central nervous system. In this paper, we reviewed the current technological status to measure biomarker for closed-loop neuromodulation systems for voiding dysfunction.
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Garcia MBS, Pereira JS. Electrostimulation of the posterior tibial nerve in individuals with overactive bladder: a literature review. J Phys Ther Sci 2018; 30:1333-1340. [PMID: 30349175 PMCID: PMC6181669 DOI: 10.1589/jpts.30.1333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/20/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aims to gather scientific evidence to identify whether clinical
trials on Electrostimulation of the Posterior Tibial Nerve (ESPTN) in individuals with
overactive bladder present an adequate methodological standard according to the PEDro
(Physiotherapy Evidence Database) criteria. [Methods] Integral literature review,
including randomized controlled clinical trials found in PEDro. [Results] We found 16
articles, of which only one did not meet the inclusion criteria. This article has shown
that ESPTN is a conservative tool of physiotherapy that is less invasive than other
therapies, is well tolerated by patients and has been shown to be effective in the
treatment of overactive bladder. However, few standardized clinical studies have been
conducted, and only 26.6% of the articles included in this review obtained a score of more
than five items on the PEDro scale. [Conclusion] This article has shown that ESPTN is a
conservative tool of physiotherapy that is less invasive than other therapies, is well
tolerated by patients and has been shown to be effective in the treatment of overactive
bladder. Thus, there is a need for more clinical articles that follow the quality criteria
for randomized clinical trials, allowing more reliable scientific results.
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Affiliation(s)
- Marilia Barbosa Santos Garcia
- Sector of Movement Disorders, Department of Neurology, Pedro Ernesto University Hospital, Rio de Janeiro State University: Av. 28 de Setembro, 77, 2° andar, Vila Isabel, CEP 20550-030, Rio de Janeiro, RJ, Brazil.,Postgraduate Program Sensu Stricto in Medical Sciences, Faculty of Medical Sciences, Rio de Janeiro State University
| | - João Santos Pereira
- Sector of Movement Disorders, Department of Neurology, Pedro Ernesto University Hospital, Rio de Janeiro State University: Av. 28 de Setembro, 77, 2° andar, Vila Isabel, CEP 20550-030, Rio de Janeiro, RJ, Brazil
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Barbosa AMP, Parizotto NA, Pedroni CR, Avila MA, Liebano RE, Driusso P. How to report electrotherapy parameters and procedures for pelvic floor dysfunction. Int Urogynecol J 2018; 29:1747-1755. [PMID: 30143853 DOI: 10.1007/s00192-018-3743-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/31/2018] [Indexed: 12/12/2022]
Abstract
Electrical stimulation is widely used for pelvic floor muscle dysfunctions (PFMDs), but studies are not always clear about the parameters used, jeopardizing their reproduction. As such, this study aimed to be a reference for researchers and clinicians when using electrical stimulation for PFMD. This report was designed by experts on electrophysical agents and PFMD who determined all basic parameters that should be described. The terms were selected from the Medical Subject Headings database of controlled vocabulary. An extensive process of systematic searching of databases was performed, after which experts met and discussed on the main findings, and a consensus was achieved. Electrical stimulation parameters were described, including the physiological meaning and clinical relevance of each parameter. Also, a description of patient and electrode positioning was added. A consensus-based guideline on how to report electrical stimulation parameters for PFMD treatment was developed to help both clinicians and researchers.
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Affiliation(s)
- Angélica Mércia Pascon Barbosa
- School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, São Paulo State University (UNESP), Av. Hygino Muzzi Filho, 737, Bairro: Mirante, Marília, SP, CEP:17.525-900, Brazil.
| | - Nivaldo Antonio Parizotto
- Post-Graduate Program of Biotechnology on Regenerative Medicine and Medical Chemistry, University of Araraquara, (UNIARA), Araraquara, SP, Brazil.,Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Cristiane Rodrigues Pedroni
- School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, São Paulo State University (UNESP), Av. Hygino Muzzi Filho, 737, Bairro: Mirante, Marília, SP, CEP:17.525-900, Brazil
| | - Mariana Arias Avila
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.,Research Nucleus on Electrophysical Agents (Núcleo de Pesquisa em Agentes Eletrofísicos - NUPE), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Richard Eloin Liebano
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.,Research Nucleus on Electrophysical Agents (Núcleo de Pesquisa em Agentes Eletrofísicos - NUPE), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Patricia Driusso
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.,Research Nucleus on Electrophysical Agents (Núcleo de Pesquisa em Agentes Eletrofísicos - NUPE), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
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Lasak AM, Jean-Michel M, Le PU, Durgam R, Harroche J. The Role of Pelvic Floor Muscle Training in the Conservative and Surgical Management of Female Stress Urinary Incontinence: Does the Strength of the Pelvic Floor Muscles Matter? PM R 2018; 10:1198-1210. [PMID: 29753829 DOI: 10.1016/j.pmrj.2018.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/06/2018] [Accepted: 03/02/2018] [Indexed: 01/23/2023]
Abstract
The purpose of this review is to provide an in-depth overview of the role of pelvic floor muscle (PFM) training in the management of stress urinary incontinence (SUI). The definition, epidemiology, and pathogenesis of SUI are described. We review the anatomy of the PFM and the importance of PFM strength in maintaining urinary continence and establishing normal voiding function. A brief description of the surgical options currently available for SUI and the existing data regarding the role of perioperative PFM training for SUI are included. Critical research questions to better evaluate and assess PFM training during the perioperative period are proposed. Promising novel approaches in the treatment of SUI are also presented. This review is useful for physiatrists, urogynecologists, female urologists, and nurse practitioners who specialize in the management and treatment of women with SUI. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Anna Maria Lasak
- Department of Rehabilitation Medicine, Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, Bronx, NY(∗)
| | | | - Phuong Uyen Le
- Department of Rehabilitation Medicine, Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, 150 East 210(th) Street, 2(nd) floor, Bronx, NY 10467(‡).
| | - Roshni Durgam
- Department of Rehabilitation Medicine, Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, Bronx, NY(§)
| | - Jessica Harroche
- Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, Bronx, NY(¶)
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The role of nonpharmacologic therapies in management of chronic pelvic pain: what to do when surgery fails. Curr Opin Obstet Gynecol 2018; 29:231-239. [PMID: 28604402 DOI: 10.1097/gco.0000000000000376] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW To provide an update on nonsurgical and nonpharmacologic strategies for the management of chronic pelvic pain (CPP). RECENT FINDINGS Effective treatment of patients with CPP requires a multifaceted approach, with thoughtful consideration of surgical, pharmacologic, and nonpharmacologic strategies. Evidence for physical therapy and trigger point injections for treatment of myofascial components of CPP is increasing. Neuromodulation techniques, such as percutaneous tibial nerve stimulation and transcutaneous electrical stimulation, have limited but favorable preliminary data in patients with CPP. Behavioral strategies, such as exercise, cognitive behavioral therapy, and mindfulness, have demonstrated significant improvements in pain, function and quality of life in patients with a variety of chronic pain conditions and are promising avenues for future research in CPP. SUMMARY Nonpharmacologic therapies are important adjuncts to surgical and pharmacologic treatment for CPP and should be considered integral to a comprehensive treatment approach.
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Zhao Y, Zhou J, Mo Q, Wang Y, Yu J, Liu Z. Acupuncture for adults with overactive bladder: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e9838. [PMID: 29465566 PMCID: PMC5841968 DOI: 10.1097/md.0000000000009838] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/06/2017] [Accepted: 01/19/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Overactive bladder is stated as the occurrence of urinary urgency which will cause negative impacts and decrease patients' health-related quality of life. The aim of this systematic review is to assess the efficiency and safety of acupuncture for adults with overactive bladder (OAB) comparing with sham-acupuncture, drugs, and acupuncture plus drugs. METHODS We independently searched 9 databases from beginning to August 15, 2017. Two writers extracted data at the same time independently. Study outcomes were calculated by standardized mean differences (SMD) with 95% confidence intervals (CIs) and mean difference (MD) with 95% CIs. RESULTS Ten randomized controlled trials (RCTs) with 794 patients were included in this systematic review. The combined results showed that electroacupuncture (EA) may be more effective than sham electroacupuncture (sham EA) in improving the 24-hour nocturia episodes and EA may enhance tolterodine for relieving voiding symptoms and enhancing patients' quality of life. However, more trials with high quality and larger sample sizes will be needed in the future to provide sufficient evidence. Only 15 of 794 OAB patients from the included studies reported mild adverse reactions related to EA, therefore, acupuncture is safe for treating OAB. CONCLUSION Acupuncture might have effect in decreasing the number of micturition episodes, incontinence episodes, and nocturia episodes. However, the evidence is insufficient to show the effect using acupuncture alone or the additional effect to drugs in treating OAB.
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Affiliation(s)
- Yuwei Zhao
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- Beijing University of Chinese Medicine, Beijing
| | - Jing Zhou
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Qian Mo
- Guiyang College of Traditional Chinese Medicine, Guiyang, China
| | - Yang Wang
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Jinna Yu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Zhishun Liu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
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Keller N, Schmid S, Borcard A, Hämmerle B. [Not Available]. PRAXIS 2018; 107:263-269. [PMID: 29486647 DOI: 10.1024/1661-8157/a002901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Zusammenfassung. In der Grundversorgerpraxis ist die überaktive Blase (OAB) bei der älteren, polymorbiden Patientin ein immer häufiger auftretendes Krankheitsbild. Die OAB wird definiert als imperativer Harndrang mit oder ohne Inkontinenz sowie Pollakisurie und Nykturie ohne Harnwegsinfektion oder andere Pathologie. Die Symptomatik schränkt die Betroffenen im Alltag deutlich ein. Das Behandlungskonzept basiert auf einer Stufentherapie. Neben Verhaltensschulung und Beckenbodentherapie gibt es auch die Möglichkeit einer medikamentösen Therapie. Diese ist jedoch wegen häufiger Nebenwirkungen und Wechselwirkungen nicht für alle Patientinnen geeignet. In Kombination mit medikamentöser Therapie oder bei Kontraindikation oder Versagen derselben gibt es die Möglichkeit der perkutanen posterioren tibialen Nervenstimulation (PTNS). Diese Therapieform kann ambulant angewendet werden, ist minimalinvasiv, nebenwirkungsarm und häufig erfolgreich.
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