Elsevier

Urology

Volume 91, May 2016, Pages 64-69
Urology

Female Urology, Urodynamics, Incontinence, and Pelvic Floor Reconstructive Surgery
Efficacy of Electrical Pudendal Nerve Stimulation in Treating Female Stress Incontinence

https://doi.org/10.1016/j.urology.2016.02.027Get rights and content

Objective

To compare the efficacies of electrical pudendal nerve stimulation (EPNS) vs electromyogram biofeedback (BF)-assisted pelvic floor muscle training (PFMT) plus transvaginal electrical stimulation (TES) in treating female stress urinary incontinence (SUI) and to evaluate the posttreatment and long-term efficacies of EPNS for female SUI.

Materials and Methods

Forty-two female SUI patients were randomized into groups I and II, 21 in each group. The two groups were treated by EPNS and BF-assisted PFMT plus TES, respectively, for comparison of their effects. Group III (196 patients) were treated by EPNS for evaluation of its effects. To perform EPNS, long acupuncture needles were deeply inserted into four sacrococcygeal points and electrified to stimulate pudendal nerves. Outcome measures were stress test, 24-hour pad test, and a questionnaire to measure the severity of symptoms and quality of life in women with SUI.

Results

After 4 weeks of treatment, the questionnaire score was lower and the therapeutic effect was better in group I (questionnaire score 0 [0, 6] and a ≥ 50% symptom improvement rate of 85.7%, respectively) than in group II (questionnaire score 9 [5.5, 15.5] and a ≥ 50% symptom improvement rate of 28.6%) (both P < .01). In group III, complete resolution occurred in 94 cases (48.0%), with a ≥ 50% symptom improvement rate of 85.7%, after 20.3 ± 16.8 sessions of treatment. At the mean follow-up of 52.9 months, complete resolution occurred in 32 (47.1%) of the 68 patients in group III who attained ≥50% posttreatment improvement.

Conclusion

EPNS is more effective than BF-assisted PFMT plus TES in treating female SUI. It has good posttreatment and long-term effects on female SUI.

Section snippets

Materials and Methods

A randomized controlled trial was conducted to compare the efficacies of EPNS vs BF-assisted PFMT plus TES in treating female SUI. In a pilot study with 20 women, the final size of the sample was calculated, using PASS 11 software, to be 36 patients for a power (1-beta) of 0.90, an alpha (significance level) of 0.05, and a ratio of 1:1. Considering that there might be a dropout rate of 15%, 42 female SUI patients from 63 women with incontinence who were assessed for eligibility were enrolled

Results

The duration of symptoms was 48 (18, 120) months in group I, 48 (17, 108) months in group II, and 60 (24, 120) months in group III. Parity was 1.2 ± 0.7 in group I, 1.6 ± 1.1 in group II, and 1.4 ± 0.8 in group III. Two patients (9.5%) of group I, 3 patients (14.3%) of group II, and 23 patients (11.7%) of group III had undergone hysterectomy. One patient (4.8%) of group I, 1 patient (4.8%) of group II, and 8 patients (4.1%) of group III had ≤2° uterine prolapsed. There were no significant

Comment

The site about 1 cm bilateral to the sacrococcygeal joint is close to the main PN trunk, so the body surface over it (the upper point) was selected for deep perpendicular insertion of a long needle. Because PN contains sensory fibers innervating the external genitalia and anus, the sensation is referred to the urethra or anus during needle insertion. In the ischiorectal fossa, the PN branches into (1) the perineal nerve innervating the PFM and the skin of the labium majus, and (2) the dorsal

Conclusion

EPNS is more effective than BF-assisted PFMT plus TES in treating female SUI. It has good posttreatment and long-term effects on female SUI.

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Financial Disclosure: The authors declare that they have no relevant financial interests.

Funding Support: This study was supported by grants SHDC12007217 and ZYSNXD-CC-ZDYJ010 from the Shanghai Municipal Health Bureau, and by grants 09dZ1974900 and 12401904600 from the Shanghai Municipal Science and Technology Commission.

Clinical Trial Registration clinicaltrials.gov. Identifier: NCT01763762.

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