EFFICACY OF ELECTRICAL PUDENDAL NERVE STIMULATION VERSUS TRANSVAGINAL ELECTRICAL STIMULATION IN TREATING FEMALE IDIOPATHIC URGENCY URINARY INCONTINENCE

Review written by Dr Sarah Haag info

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BACKGROUND & OBJECTIVE

Urge urinary incontinence (UUI) is often idiopathic, and can be refractory to medication. Electrical stimulation has been an alternative to pharmacological intervention for years, ranging from transvaginal electrical stimulation performed in the clinic or at home, to sacral neuromodulation, which is much more invasive and expensive. This study compared transvaginal electrical stimulation to electrical pudendal nerve stimulation.

METHODS

120 women with UUI were enrolled in this study, and randomized by drawing lots. Inclusion criteria were >18 years of age, UUI or urgency predominant mixed UI for >6 months, >1 episode of UUI per week, and UUI refractory to anticholinergic medications when 2 or more were administered for at least 6 weeks. Exclusion criteria were stress UI, pelvic, neurological or urological abnormalities.

Group 1 (n=80) was treated with electrical pudendal nerve stimulation, administered via four sacrococcygeal points with long acupuncture needles. Once placement was confirmed via ‘production of a sensation’ in the urethra and/or anus, electrical stimulation was applied with a biphasic 2-millisecond pulse duration at a frequency of 2.0 Hz and an intensity of 25 to 35 mA, for 60 minutes, 3 times per week for 3 weeks.

Group 2 (n=40) was treated with transvaginal electrical stimulation with an intensity of <60mA at a frequency of 12.5 to 30 Hz for 45 minutes 3 times per week for a total of 4 weeks. Intensity for group 2 was determined by being ‘sensed without obvious discomfort’.

The total treatment time was 540 minutes for each group.

RESULTS

Objective improvement in symptoms was measured by a 24-hour pad test, and subjective improvements were measured via a questionnaire comprised of quality of life questions, the frequency and amount of leakage, and the number of diapers or pads used. At

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