Spruijt Johan, Vierhout Mark, Verstraeten Rob, Janssens Jannes, Burger Curt
Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Acta Obstet Gynecol Scand. 2003 Nov;82(11):1043-8. doi: 10.1034/j.1600-0412.2003.00130.x.
To evaluate the effectiveness of intravaginal electrical stimulation (ES) of the pelvic floor for urinary incontinence in elderly women, and to determine whether ES of the pelvic floor is a preferable treatment for urinary incontinence in elderly women.
Postmenopausal women (age 65 years or older) were enrolled in a randomized clinical trial and underwent every-other-day ES of the pelvic floor, or a daily Kegel exercise (KE) program. Objective outcome variables were: (1) Urinary leakage (during a standardized PAD test), (2) pelvic muscle strength (measured by a perineometer), and (3) detrusor instability (on ambulant urodynamic registration). Subjective outcome variables were women's subjective assessment of change in urinary symptoms based on the PRAFAB score. Twenty-four women treated with ES and 11 women treated with Kegel exercises completed the 8-week study program. The Chi-square test was used for statistical analysis.
No significant improvement in objective outcome variables was observed in the population treated with ES compared with the population treated with KE (with 29.2% vs. 36.4% of the women showing objective improvement in measured urinary leakage). Neither was subjective improvement significant, with 29.2% vs. 27.3% of the women reporting improvement in the amount of urinary leakage.
Although the number of enrolled women was very small this study shows that: 1. Treating elderly women with vaginal ES of the pelvic floor has a high physical and emotional cost for the individual. 2. The effectiveness of ES of the pelvic floor in urinary incontinent elderly women is low. 3. There is no great discrepancy between objective amelioration (PAD test) and subjective amelioration (PRAFAB score/quantity of urinary leakage), if the objective improvement is adequately defined. 4. It is not reasonable to advise elderly women with urinary incontinence to undertake this treatment procedure. The effectiveness of treatment does not compensate for the long-lasting and intense treatment protocol. 5. We terminated this study because of the negative outcome with ES.
评估盆底阴道内电刺激（ES）治疗老年女性尿失禁的有效性，并确定盆底ES是否为老年女性尿失禁的首选治疗方法。
绝经后女性（年龄65岁及以上）被纳入一项随机临床试验，接受隔日盆底ES或每日凯格尔运动（KE）方案。客观结果变量为：（1）漏尿（在标准化卫生巾试验期间），（2）盆底肌肉力量（通过会阴压力计测量），以及（3）逼尿肌不稳定（在动态尿动力学记录时）。主观结果变量为女性基于PRAFAB评分对尿路症状变化的主观评估。24名接受ES治疗的女性和11名接受凯格尔运动治疗的女性完成了为期8周的研究方案。采用卡方检验进行统计分析。
与接受KE治疗的人群相比，接受ES治疗的人群在客观结果变量方面未观察到显著改善（分别有29.2%和36.4%的女性在测量的漏尿方面有客观改善）。主观改善也不显著，分别有29.2%和27.3%的女性报告漏尿量有所改善。
尽管入组女性数量非常少，但本研究表明：1. 对老年女性进行盆底阴道内ES治疗对个体有较高的身体和情感成本。2. 盆底ES治疗老年尿失禁女性的有效性较低。3. 如果客观改善得到充分定义，客观改善（卫生巾试验）和主观改善（PRAFAB评分/漏尿量）之间没有很大差异。4. 建议老年尿失禁女性进行这种治疗程序是不合理的。治疗效果无法弥补长期且强烈的治疗方案。5. 由于ES治疗结果为阴性，我们终止了本研究。
