The Short-term Effect Of Intensive Biofeedback Combined With Home Pelvic Floor Training On Female Stress Urinary Incontinence

Background and ObjectiveStress urinary incontinence(SUI) is the complaint of involuntary leakage of urine on effort or exertion, or on sneezing or coughing. The urine leakage during stress without a detrusor contraction is defined as genuine stress urinary incontinence (GSUI). GSUI is one of the most frequent female bladder dysfunction, it has high case rate and seriously influence quality of patient life. GSUI is common in middle-aged and elderly women. According to epidemiological researches, GSUI is the result of some associated risk factors, such as age, obesity, menopause, pregnancy and vaginal delivery, pelvic surgery, and so on. The operation of moderate and severe GSUI has got great improvement, but it has many disadvantage, for example traumatic occlusion, high expense, concurrent disease, et al. At present, there is not suitable non-operative therapy for mild SUI. it is gradually received for clinician that biofeedback is used to treat SUI, but indication and curative effect are still disputed. Therefore, the aims of this study was to investigate the short-term effect of intensive biofeedback combined with home pelvic floor training on GSUI. Materials and MethodsMaterialsFifty women with GSUI which was confirmed by urodynamic studies performed in the Urodynamic Center of First Affiliated Hospital of Zhengzhou University China from May 2006 to June 2007. All patients that could contract and relax their pelvic muscle effectively during treatment, were included. According to clinical symptom, 50 women with GSUI were divided into three groups: mild, moderate and severe group, respectively including 20(averaged 41±13 year-old), 15 (averaged 43±11 year-old) and 15(averaged 46±18 year-old) patients.MethodsIntensive biofeedback combined with pelvic floor training was performed on all patients three times a week for twelve weeks, the change of pelvic myoelectricity and rectum pressure was detected by Urodynamic system. The first four weeks, pelvic myoelectricity and rectum pressure increase gradually to 130% of outset treatment, which was retained to termination. After every time treatment, the patients were required to contract pelvic floor at home. Urinary diary, the score of international continence inquiring committee's questionnaire (ICI-Q-SF) and urodynamics evaluation were completed before and after treatment. Three months later, follow-up visit was carried out at outpatient department or with telephone.Statistical analysisStatistical Package for Social Sciences (SPSS), version 11.0, for Windows, was used for Statistical analyses. Results were expressed as mean±standard deviation (SD). The two-samples t-test for paired sample, single factor analysis of variance and the Chi-square test was used to assess differences. P values less than 0.05 were considered to be statistically significant.ResultsIn the three groups, valsalva leak point pressure(Pvlp) and maximum urethral closure pressure(Pmuc) were significantly higher than those before treatment, leakage times (LT)and the scores of ICI-Q-SF significantly lower than those before treatment (P < 0.05).After treatment, the scores of ICI-Q-SF and LT in mild group were significantly lower than that in both other groups, however, functional voided volume(VF), Pvlp and Pmuc were significantly higher than those in both other groups; Moreover, the times of voiding and ICI-Q-SF in moderate group were significantly lower than those in severe group, VF and Pvlp were significantly higher than those in severe group.The effective rate in mild group at three months after treatment was 95%, significantly higher than that in moderate group and severe group (67% and 53%) (P < 0.05).ConclusionThe intensive biofeedback combined with home pelvic floor training is a usefultherapy to treat women with mild GSUI.