engleski

Comparison of efficacy of extracorporeal magnetic innervation and Kegel exercises for stress urinary incontinence in adult women: study protocol for a randomized controlled trial

Stress urinary incontinence (SUI) is defined as a complaint of inadvertent loss of urine occurring as a result of an increase in intraabdominal pressure, in the absence of a detrusor muscle contraction [1]. Estimates of the prevalence vary widely in the published literature, due in part to differing terminologies, diagnostic approaches, and populations studied [1–3]. It has been reported that SUI affects up to 14% of premenopausal women and up to 35% of postmenopausal women [4, 5], unfavourably affecting quality of life (QoL), sexual function, and mental health [6, 7]. Pathophysiologically, SUI is caused by urethral deficiency and impairment of supportive structures such as the levator ani muscle, endopelvic fascia, and pubourethral ligament [8]. The beneficial effect of pelvic floor muscle training (PFMT) on female urinary incontinence and pelvic organ prolapse was first described in 1948 by Arnold Kegel, who reported an astonishing success rate of 84% [9]. More recent studies have demonstrated somewhat lower success rates of PFMT than those reported by Kegel, but still in the impressive range from 56 to 75% based on improved clinical outcomes [10]. Strong evidence and grade A recommendations support the use of PFMT as the first-line conservative treatment for SUI [11]. Although alternative exercise regimens for SUI have been investigated, their clinical implementation is not yet recommended [12]. Other conservative therapeutic options for SUI include vaginal cones, bladder training, as well as electrical or magnetic stimulation. Extracorporeal magnetic stimulation (EMS) is a non-invasive, effective, acceptable, and safe therapeutic modality for SUI [6, 7]. In EMS, induction of a changing magnetic field results in a flow of electrons within the field, controlled depolarisation of the adjacent nerves, and subsequent muscular contraction [13]. Although the optimal frequency and duration of treatment are not yet established, findings of a systematic review have suggested that higher frequency and pulse duration provide an adequate modality for achieving treatment efficacy [14]. At our clinic, which is the largest Croatian urogynaecological referral centre, EMS is routinely offered as an alternative to women who are not willing to perform Kegel exercises. Considering that a direct comparison of these two common conservative methods is lacking, we decided to perform a randomized controlled trial comparing the efficacy of PFMT versus EMS for the treatment of SUI. In this paper we describe the protocol of the study.

stress urinary incontinence ; Kegel exercises ; extracorporeal magnetic innervation ; randomized controlled trial ; protocol

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