General Obstetrics and Gynecology: Gynecology
Who will benefit from pelvic floor muscle training for stress urinary incontinence?

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Objective

The purpose of this study was to determine which patient characteristics are predictive of outcome before pelvic floor muscle training for stress urinary incontinence.

Study design

This was an observational study at a single-center outdoor patient clinic in Brussels, Belgium, that comprised 447 women, aged 26 to 80 years (mean, 52.7 years), who had urinary stress incontinence. All the women received individual pelvic floor muscle training under the guidance of the same physiotherapist. Twenty-two patient characteristics were considered for outcome measurements.

Results

Forty-nine percent of the women considered their treatment to be successful; 51% of the women had experienced only some improvement, no change, or a worsening of their condition or had interrupted therapy. Three independent predictors of treatment failure were ≥2 leakages per day before treatment (P < .0001), the chronic use of psychotropic medication (P = .002), and a baseline positive stress test result at first cough (P = .042). The odds were only 15% for an individual patient to be treated successfully when these 3 predictors were present.

Conclusion

Pelvic floor muscle training is beneficial in one half of the patients who are treated in this manner. Two or more leakages per day at baseline and the chronic use of psychotropic medication significantly predicted therapy failure.

Section snippets

Methods

Between January 1, 1990, and December 31, 2001, 447 women with stress urinary incontinence who attended at least 1 session of PFMT under the guidance of our physiotherapist (M.V.N.) were included in the study. Institutionalized, hospitalized, demented, functionally invalid, postpartum patients and women with an overactive detrusor or a residual urine after micturition that exceeded 100 mL were excluded.

All of the women had cystometry and a stress test. The technique was carried out in the

Results

Of the 447 women who were included, 82 women (18%) were felt to be cured, and 139 women (31%) were improved considerably. Therefore, 221 women (49%) could be said to have been treated successfully. One hundred six women (24%) showed only some improvement, and 75 women (17%) were felt to be unchanged or worse. Forty-five women (10%) dropped out. Hence, in 226 women (51%), PFMT was thought to have failed. The average number of completed PFMT sessions in the successful group was 11.2 (SD, 5.6;

Comment

This study reports on the outcome of 447 women with stress urinary incontinence who followed PFMT under the guidance of a same physiotherapist. We tried to identify clinical factors that are predictive of response to treatment.

The International Consultation on Incontinence Committee on Conservative Treatment in Women concluded that “many of the factors traditionally supposed to affect outcomes of physical therapy interventions may be less crucial than previously thought. The single factor that

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