RESUMO
Background: Stress urinary incontinence (SUI) presents as unintentional urine leakage associated with activities. It significantly affects quality of life (QoL) and is the most common type of incontinence in women. Current treatment options, particularly non-surgical therapies, are lacking. Objective: To assess the efficacy of mechanotherapy provided by the Flyte® intra-vaginal device during pelvic floor muscle training (PFMT). Design: This was a randomized, controlled, double-blinded trial. Materials and methods: Flyte is a repeat use device for conditioning and strengthening the pelvic floor muscles (PFMs). It provides two-part mechanotherapy. Part 1 is the stretching and preloading of the PFM from the internal wand. Part 2 integrates mechanical pulses which elicit muscle cellular and tissue level responses that trigger cellular regeneration, improve neuromuscular facilitation and motor learning. Subjects used the device for 5 min/day for 12 weeks. Subjects (144) were randomized and evaluated at 6 and 12 weeks. Arm A (72) received both Part 1 and Part 2 mechanotherapy for 12 weeks, whereas Arm B (72) received Part 1 therapy for 6 weeks, then crossed over to full therapy. Mean age was 50, 49, respectively, prior pelvic/abdominal surgery 26%, 46%, and previous incontinence treatments 13%, 22%. The primary endpoint was 24-h pad weight (24-HR PW) at 6 weeks. Secondary endpoints were 24-HR PW at 12 weeks and QoL [International Consultation on Incontinence Questionnaire (ICIQ), Urinary Incontinence Quality of Life (IQOL)]. Results: Part 1 therapy had a greater than anticipated therapeutic effect. Thus, the study was underpowered to identify differences between study arms. Therefore, data were pooled to assess the effects of mechanotherapy. Twenty four-HR PW was significantly reduced at 6 weeks (p = <0.0001), with further reduction from 6 to 12 weeks (p = <0.0001). Data were stratified based on 24-HR PW severity. Significant reductions were noted in all severity groups (mild p = <0.0001, moderate p = <0.0001, severe p = <0.01). QoL was similarly improved at 6 weeks (ICIQ p = <0.0001, IQOL p = <0.0001), and 12 weeks (ICIQ p = <0.0001, IQOL p = <0.0001). Compliance was >80% at 6 weeks and 70% at 12 weeks. Conclusion: Two-part mechanotherapy significantly improved 24-HR PW and QoL across all severities of SUI. Improvements were noted in as little as 2 weeks and appeared to be sustained through 2-year follow up. Trial registration: Registered on ClinTrials.gov (NCT02954042).
Novel mechanical stimulation therapy for stress urinary incontinence Stress urinary incontinence is the involuntary loss of urine during activities such as sneezing, coughing, lifting and exercise. It negatively affects quality of life, and is the most common type of incontinence in women. Current treatment options, particularly non-surgical therapies, are lacking. Pelvic floor muscle training, sometimes referred to as Kegel exercise, is the usual initial therapy to treat stress urinary incontinence. This study assessed the effectiveness and safety of the two types of mechanical stimulation therapy provided by the Flyte® intra-vaginal wand during pelvic floor muscle training. The first type stretches the muscles to optimize the effect of the pelvic floor muscle exercises. The second type is the delivery of specially tuned mechanical pulses that trigger muscle cell and tissue responses that accelerate muscle cell healing, increase muscle awareness and improve coordination. Due to an inadequate number of study subjects in the two study arms, the study data were combined into one analysis group to better assess the benefits of Flyte therapy in the participants. The volume of urine loss was very significantly reduced at 6-weeks, with further reduction from 6-12 weeks. Data were then divided into subgroups based on the severity of urine loss at the beginning of the study. Very significant reductions were noted in women with Mild, Moderate and Severe incontinence. Quality of life was similarly improved at 6 and 12 weeks, as measured by two quality of life questionnaires. These improvements were noted in as little as 2 weeks. More than 80% of participants performed the therapy at 6 weeks and 70% at 12 weeks. Improved quality of life was sustained through two years after the study ended in women who voluntarily continued participation in the study.
