Transvaginal Electrical Stimulation for Treatment of Overactive Bladder Without Incontinence: A Pilot Cross-Over Clinical Trial.

IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY
Michele Torosis, Lynn Stothers, Crystal Cisneros, Georgina Dominique, A Lenore Ackerman
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引用次数: 0

Abstract

Objectives: Few studies look at therapeutic efficacy specifically in the OAB population that lacks urgency incontinence (OAB-dry). Transvaginal electrical stimulation (TES) improves urgency incontinence in OAB-wet by targeting the detrusor muscle by reflex inhibition but has not yet been trialed for the improvement of urgency and frequency symptoms alone without incontinence. This study sought to measure the efficacy of an at-home TES program on urgency and frequency symptoms alone in OAB-dry.

Methods: This was a prospective, randomized, cross-over, controlled trial of women > 18 years old presenting to a urogynecology clinic with urinary urgency and frequency without incontinence. Participants were randomized to receive 4 weeks of sham, followed by a 3-week washout period, and then 4 weeks of intervention (Arm 1), or the reverse (Arm 2). Intervention included 15 min/day of TES using a TENS unit and transvaginal probe with stimulation width of 100 µs, rate of 12 Hz, and amplitude set by participant based on sensation. Baseline bladder symptoms were captured with voiding diaries and standardized questionnaires. Standardized pelvic floor muscle exam was performed at the beginning and end of treatment. Participants were categorized as responders if the participants stated they planned to continue the TES as their primary treatment after study completion. Outcomes were compared using t-tests, χ2, and Fisher exact tests.

Results: In total, 19 enrolled and 15 (79%) completed the study and had primary outcomes data available for analysis. There were no demographic differences between arms. Mean OAB-q scores for all at baseline was 25.1, post-sham was 22.9, and post-TES was 17.60, for a mean change of -7.73 points (95% CI, -21.5 to 5.9), p = 0.007). There was a reduction in voids per 24 h from 11.3 (± 3.7) to 9.0 (± 3.6) posttreatment (p = 0.048). Response, defined as continuation of therapy, had a significant association with lack of pelvic floor tenderness on baseline standardized exam (OR 0.96, CI 0.94-0.99).

Conclusions: These data suggest there are two phenotypes within OAB-dry, those with pelvic floor myofascial dysfunction that do not respond to bladder directive therapy, and those who represent a population of less severe OAB-wet with detrusor overactivity, which respond to bladder directive therapy. TES is a viable treatment option for this population, resulting in clinically significant improvements in urinary symptoms and patient-reported disease severity.

Trial registration: ClinicalTrials.gov: NCT04957524.

经阴道电刺激治疗膀胱过度活动无尿失禁:一项试点交叉临床试验。
目的:很少有研究专门研究OAB人群缺乏急迫性尿失禁(OAB-dry)的治疗效果。经阴道电刺激(TES)通过反射抑制靶向逼尿肌来改善OAB-wet患者的急迫性尿失禁,但尚未进行单独改善急迫性和频率症状而无尿失禁的试验。本研究旨在测量家庭TES方案对OAB-dry患者急迫性和频率症状的疗效。方法:这是一项前瞻性、随机、交叉、对照试验,患者年龄在18岁至18岁之间,以尿急和尿频就诊于泌尿妇科诊所,但未出现尿失禁。参与者随机接受4周的假手术,随后是3周的洗脱期,然后是4周的干预(第1组),或者相反(第2组)。干预包括15分钟/天的TES,使用TENS装置和经阴道探针,刺激宽度为100µs,频率为12 Hz,振幅由参与者根据感觉设定。用排尿日记和标准化问卷记录膀胱基线症状。在治疗开始和结束时进行标准化盆底肌肉检查。如果参与者表示他们计划在研究完成后继续将TES作为主要治疗,则将其归类为应答者。结果比较采用t检验、χ2和Fisher精确检验。结果:共有19名入组患者,15名(79%)完成了研究,并有可用于分析的主要结局数据。兵种之间没有人口统计学上的差异。基线时所有患者的OAB-q平均得分为25.1,假手术后为22.9,tes后为17.60,平均变化为-7.73分(95% CI, -21.5至5.9),p = 0.007)。治疗后每24 h的空腔数从11.3(±3.7)个减少到9.0(±3.6)个(p = 0.048)。缓解,定义为继续治疗,与基线标准化检查中盆底压痛的缺失有显著相关性(OR 0.96, CI 0.94-0.99)。结论:这些数据表明,在oab -干型患者中存在两种表型,即盆底肌筋膜功能障碍患者对膀胱指导治疗无反应,而那些较轻的oab -湿型患者伴逼尿肌过度活动,对膀胱指导治疗有反应。TES是这一人群的一种可行的治疗选择,可显著改善泌尿系统症状和患者报告的疾病严重程度。试验注册:ClinicalTrials.gov: NCT04957524。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurourology and Urodynamics
Neurourology and Urodynamics 医学-泌尿学与肾脏学
CiteScore
4.30
自引率
10.00%
发文量
231
审稿时长
4-8 weeks
期刊介绍: Neurourology and Urodynamics welcomes original scientific contributions from all parts of the world on topics related to urinary tract function, urinary and fecal continence and pelvic floor function.
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