Long-term sacral magnetic stimulation for refractory stress urinary incontinence.

OBJECTIVE: To evaluate the effects of sacral magnetic stimulation (SMS) on functional and urodynamic improvement in patients with refractory stress urinary incontinence (SUI). DESIGN: A sham-controlled, double-blind, parallel study design with a 4.5-month follow-up. SETTING: A tertiary hospital. PARTICIPANTS: Women (age, 45-75y) with SUI refractory to first-line management (N=34) were allocated to either an experimental (n=20) group or a sham (n=14) group. INTERVENTIONS: The SMS protocol consisted of 5-Hz, 20-minute treatments administered over the bilateral third sacral roots, with the intensity set at approximately 70% of the maximal output, for 12 consecutive weekdays. MAIN OUTCOME MEASURES: Urodynamic assessments and 2 life stress questionnaires, namely, the Urge-Urinary Distress Inventory (U-UDI) and the Overactive Bladder Questionnaire (OAB-q), were administered pre- and post-SMS intervention. We administered the U-UDI (primary outcome measure) and the OAB-q at 3-week intervals during the follow-up period until 18 weeks after the final intervention. RESULTS: The experimental group exhibited significant improvements in both U-UDI and OAB-q scores postintervention (P=.011-.014) and at follow-up visits (P<.001-.007) compared with the sham group. In addition, significant increases in bladder capacity, urethral functional length, and the pressure transmission ratio (P=.009-.033) were noted postintervention. Multivariate regression analysis revealed that patients with more severe symptoms benefited more from SMS. A poorer baseline U-UDI score and a shorter urethral functional length were associated with a greater response to SMS. CONCLUSIONS: Our observations of a greater response to SMS in patients with more severe SUI than in those with mild symptoms, as well as the long-term benefits of the treatment, confirm the efficacy of SMS in treating SUI.

Efficacy of spinal magnetic stimulation in elderly persons with chronic constipation.

BACKGROUND: The development of primary constipation in elderly adults usually has a multifactorial etiology. Slow transit constipation and pelvic floor dysfunction (PFD) are the two most commonly seen constipation subtypes in the elderly. PFD is usually a persistent condition that remains unresponsive to treatment in spite of various therapies currently available to relieve constipation. The aim of this study was to assess the usefulness of spinal magnetic stimulation (SMS) in controlling intractable constipation in elderly patients. METHODS: Nineteen patients over the age of 65 with intractable constipation were enrolled in this study, and participated in a 12-session magnetic conditioning protocol consisting of a 20-minute stimulation session once daily. Colonic transit time (CTT) and the dynamics of evaluation as revealed in defecography were measured, and the Knowles-Eccersley-Scott Symptom (KESS) Questionnaire was administered before the intervention, and after finishing the protocol. RESULTS: There was a statistically significant improvement in CTT and defecography following the intervention. The difference in the anorectal angles between resting and evacuation (p = 0.001) and the changes in pelvic floor descent (p = 0.011) both reached significance after the intervention. The mean CTT (p = 0.001), Knowles-Eccersley-Scott Symptom score (p = 0.001), frequency of bowel movement (p = 0.005), unsuccessful evacuation (p = 0.018), and time needed for bowel hygiene (p = 0.032) all showed marked improvement after SMS conditioning. CONCLUSION: Our findings reveal that SMS intervention may benefit elderly patients with severe constipation. The amelioration of geriatric bowel dysfunction across the subtypes of slow transit constipation and PFD indicated that SMS, featuring broad-spectrum applications, can be an effective form of adjuvant treatment in the care of elderly adults.

Functional magnetic stimulation in constipation associated with Parkinson's disease.

OBJECTIVE: The aims of this study were: (i) to investigate the effect of functional magnetic stimulation on total colonic transit time in patients with Parkinson's disease; (ii) to compare the changes in dynamic recto-anal behaviour during filling and defaecation in response to this regimen; and (iii) to study the carry-over effects with a 3-month follow-up. DESIGN: A longitudinal, prospective before-after trial. SUBJECTS: Sixteen patients with Parkinson's disease enrolled in this study. No subject withdrew from the study as a result of serious adverse events. METHODS: A 3-week magnetic conditioning protocol, consisting of a 20-min stimulation session twice daily. Colonic transit time, Knowles-Eccersley-Scott Symptom Questionnaire and the dynamics of defecography were carried out before the intervention and on the final day of the protocol. RESULTS AND CONCLUSION: There was a statistically significant reduction in colonic transit time and in the questionnaire score following the intervention. The difference in the anorectal angles between resting and evacuating process and the changes in pelvic floor descent all reached significance after the intervention. The therapeutic effects that achieved significance remained constant in the 3-month follow-up result. Functional magnetic stimulation may facilitate colonic motility in Parkinson's disease and straighten the anorectal angle, allowing smooth access of rectal contents to the anal canal.

Efficacy of functional magnetic stimulation in neurogenic bowel dysfunction after spinal cord injury.

OBJECTIVE: The aims of this study were to assess the usefulness of functional magnetic stimulation in controlling neurogenic bowel dysfunction in spinal cord injured patients with supraconal and conal/caudal lesions, and to investigate the efficacy of this regimen with a 3-month follow-up. DESIGN: A longitudinal, prospective before-after trial. SUBJECTS: A total of 22 patients with chronic spinal cord injured and intractable neurogenic bowel dysfunction. They were divided into group 1 (supraconal lesion) and group 2 (conal/caudal lesion). METHODS: The colonic transit time assessment and Knowles-Eccersley-Scott Symptom Questionnaire were carried out for each patient before they received a 3-week functional magnetic stimulation protocol and on the day following the treatment. RESULTS AND CONCLUSION: Following functional magnetic stimulation, the mean colonic transit time for all patients decreased from 62.6 to 50.4 h (p<0.001). The patients' Knowles-Eccersley-Scott Symptom scores decreased from 24.5 to 19.2 points (p<0.001). The colonic transit time decrement in both group 1 (p=0.003) and group 2 (p=0.043) showed significant differences, as did the Knowles-Eccersley-Scott Symptom score in both groups following stimulation and in the 3-month follow-up results (p<0.01). The improvements in bowel function indicate that functional magnetic stimulation,featuring broad-spectrum application, can be incorporated successfully into other therapies as an optimal adjuvant treatment for neurogenic bowel dysfunction resulting from spinal cord injury.