Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study

ABSTRACT Introduction This study compared percutaneous tibial nerve stimulation (PTNS) versus electrical stimulation with pelvic floor muscle training (ES + PFMT) in women with overactive bladder syndrome (OAB). Materials and Methods 60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS. Results A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS. Conclusion This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS.

Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study.

INTRODUCTION: This study compared percutaneous tibial nerve stimulation (PTNS) versus electrical stimulation with pelvic floor muscle training (ES + PFMT) in women with overactive bladder syndrome (OAB). MATERIALS AND METHODS: 60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS. RESULTS: A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS. CONCLUSION: This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS.

Polyacrylamide hydrogel (bulkamid®) in female patients of 80 or more years with urinary incontinence.

INTRODUCTION: To assess the effectiveness of polyacrylamide hydrogel (Bulkamid®) in injection therapy for urinary incontinence in women of 80 or more years. MATERIALS AND METHODS: Twenty consecutive women mean age 84.5 (range 80-87) with stress or mixed urinary incontinence were enrolled in this prospective study. All subjects were evaluated at baseline and re-evaluated 7 days, 6,12,18 and 24 months after treatment. A detailed clinical evaluation, physical examination, daily pad count, urodynamic investigation and evaluation of urethral mobility by trans-labial ultrasound were performed. RESULTS: A statistically significant decrease in the number of pads was observed in the follow-up (p = 0.0002 after 24 months). Physical examination showed a statistically significant lack or reduced lost of urine with stress test (p = 0.0163 after 24 months). Urodynamic findings showed an increase of Valsalva leak point pressure, maximum urethral closure pressure and functional length. Maximum flow and post void residual were respectively observed to be significantly reduced and increased only after 7 days from injection therapy. Quality of life (QoL) assessed with the Incontinence Impact questionnaire short form (IIQ-7) showed a statistically significant improvement (p = 0.0001 after 24 months). Patient satisfaction assessed with the Visual Analogue Scale and Patient Global Impression of Improvement questionnaire respectively produced evaluation of ″satisfied″ and "much improved" even after 24 months. CONCLUSIONS: Polyacrylamide hydrogel (Bulkamid®) is an effective treatment with low morbility in patients of 80 or more years.

Effect of different sized transurethral catheters on pressure-flow studies in women with lower urinary tract symptoms.

INTRODUCTION: The study evaluates the impact of three different sized (4.5-, 6- and 7-Fr) catheters on pressure-flow studies in women undergoing urodynamic evaluation for lower urinary tract symptoms. MATERIAL AND METHODS: 60 women referred for the evaluation of lower urinary tract symptoms were enrolled in this randomized controlled study. Patients were divided into two groups (A and B) of 30 women each. The patients underwent non-invasive free-flow uroflowmetry with determination of post-void residual urine volume (PVR) and two consecutive pressure-flow studies using two different transurethral catheters. In group A the two consecutive pressure-flow studies were performed using a 4.5-Fr catheter once and a 6-Fr catheter once; in group B the two consecutive pressure-flow studies were performed using a 4.5-Fr catheter once and a 7-Fr catheter once. Patients were also randomized for the consecutive order in which the two different transurethral catheters were used. RESULTS: The pressure-flow parameters were significantly different from the equivalent free-flow findings. The maximum and average flow rate in all pressure-flow studies performed were significantly lower than the equivalent free-flow parameters and the flow time was significantly longer for all pressure-flow versus free-flow studies. Furthermore, there was a significantly larger PVR for pressure-flow than for free-flow measurements. There was no significant difference in maximum flow rate, average flow rate and flow time between 4.5- and 6-Fr pressure-flow studies (group A). However, there was a statistically significant difference between 4.5- and 7-Fr pressure-flow studies (group B) in those uroflowmetry parameters. Detrusor pressure at maximum flow (Pdet. Qmax) and maximum detrusor pressure (P(det. max)) in group A did not show statistically significant differences between 4.5- and 6-Fr pressure-flow studies whereas in group B Pdet. Qmax and P(det. max) were significantly different between 4.5- and 7-Fr pressure-flow studies. CONCLUSIONS: A 4.5-, 6- or 7-Fr transurethral catheter may obstruct micturition changing uroflowmetry parameters. A statistically significant difference was found in all but PVR parameters particularly in all detrusor parameters between 4.5- vs. 7-Fr whereas no statistically significant difference was found in all but PVR parameters between 4.5- vs. 6-Fr. We can thus state that pressure-flow findings may be influenced by different sized transurethral catheters. A misinterpretation of pressure-flow findings may have clinical implications on establishing an accurate diagnosis.