Intravaginal electrical stimulation for the treatment of pelvic floor dysfunction: a systematic review and meta-analysis
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Background Intravaginal electrical stimulation (IVES) has been explored as a potential treatment for pelvic floor disorders (PFDs), although its efficacy remains a subject of debate. We aim to conducted a comprehensive meta-analysis of relevant trials. Methods This meta-analysis was performed under the PRISMA 2020 guideline. We meticulously searched for randomized controlled trial (RCT) studies in various databases, including PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov , spanning from inception to March 6, 2023. All studies included one treatment group of intravaginal electrical stimulation and the diseases spectrum of the studies involved different kinds of PFDs, including urinary incontinence, overactive bladder, etc. Risk of bias charts were used to assess the risk of bias in the studies and forest plots were used the demonstrate the overall effects. Results Our analysis encompassed a total of 13 RCT studies. In most of the assessed PFD cure outcomes, the results demonstrated positive effects of IVES therapy, as indicated by the following findings: daily voiding frequency (MD = −1.57, 95% CI = −3.08 to −0.06, I 2 = 68%,), nocturia (MD = −1.07, 95% CI = −2.01 to −0.13, I 2 = 71%), Pad test, and Urinary incontinence. Nevertheless, the data concerning the impact of IVES therapy on the quality of life of individuals with PFDs did not confirm these positive results. Discussion In light of the insufficiency in both the quality and quantity of the included studies, it is premature to draw a definitive conclusion regarding the efficacy of IVES therapy for treating PFDs. Nonetheless, our study does provide several pieces of evidence in support of the potential therapeutic effects of electrical stimulation therapy in this context. We recommend that further research in this area be conducted to provide more conclusive insights into the efficacy of IVES therapy for PFDs. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier: CRD42023442171.Keywords:
Nocturia
Guideline
Urinary urgency
Pelvic Floor Dysfunction
Abstract Aim To determine the relation between urgency alone, or in combination with frequency and nocturia, and adaptive behavior in overactive bladder (OAB) syndrome. Methods We used survey data from the General Longitudinal Overactive Bladder Evaluation (GLOBE) of primary care patients over 40. Participants (n = 2,752: 1,557 females; 1,195 males) completed the same survey at two time points, 6 months apart. Questions assessed OAB symptoms and adaptive behavior. We estimated correlation coefficients (R 2 ) between urgency, frequency, and nocturia symptom scores (alone and in combination) and adaptive behavior measures at baseline and change in symptom scores and behavioral measures from baseline to 6 months. Results At baseline, urgency was the dominant predictor of all behavioral measures for females (R 2 = 0.19–0.48) and males (R 2 = 0.15–0.39). Lower R 2 values were observed for the change in measures from baseline to 6 months, but again change in urgency was the strongest predictor of change in adaptive behavior (R 2 = 0.04–0.13 in females, and 0.02–0.08 in males). The correlation between symptoms and measures of adaptive behavior was almost completely explained by the urgency score. Frequency and nocturia did not substantially improve the overall correlation. Conclusion The relation between measures of OAB symptoms and adaptive behavior at baseline and over time are largely explained by urgency, not by frequency and nocturia. Neurourol. Urodynam. 30:406–411, 2011. © 2011 Wiley‐Liss, Inc.
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We determined overactive bladder symptoms in combination with other lower urinary tract symptoms and illustrated their relationships using a statistical analysis. Furthermore, we also describe the potential contributory factors and adaptation strategies in patients that are associated with overactive bladder subtypes.A total of 1,930 women with a mean age ± SD of 46 ± 15 years (range 15 to 91) with troubling lower urinary tract symptoms were successfully interviewed with a validated questionnaire at the urology and urogynecology clinics at 14 medical centers in Taiwan. The questionnaire was constructed to evaluate 6 lower urinary tract symptoms and 7 adaptation strategies. A log linear statistical model and multiple logistic regression analysis were used to assess the associations among lower urinary tract symptoms and the potential overactive bladder contributory factors, respectively.No single or isolated symptom presented in patients with overactive bladder. Most patients reported a combination with other lower urinary tract symptoms. These female patients can be categorized into 3 groups, including 1 is associated with dry symptoms (urgency, frequency and nocturia), 1 associated with wet symptoms (urgency, urge incontinence and mixed stress incontinence) and a small group that may have overactive bladder symptoms combined with voiding difficulty symptoms. in contrast to patients with dry overactive bladder (urgency associated with frequency and/or nocturia without urge incontinence), after multiple logistic regression analysis patients with wet overactive bladder (urgency with urge incontinence) had a greater average age and higher body mass index, and made more adaptation efforts (p <0.05).We used statistical analysis to determine and suggest that urgency is the core symptom of female overactive bladder syndrome and there are 3 distinctive overactive bladder subtypes, which differ in their symptom combinations. Different symptom combinations and patient characteristics affect female adaptation to overactive bladder syndrome.
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Background: Urinary system involvement is a well-known extraglandular manifestation in primary Sjogren ’ s syndrome (pSS). The term “ Overactive Bladder ” (OAB) is used to define the symptom complex of urinary urgency, generally accompanied by nocturia, with or without urinary incontinence, in the absence of urinary tract infection or other obvious pathologies. In our study, the frequency of OAB was investigated in patients with pSS and compared with the frequency observed in normal healthy controls (NHC). Methods: In this cross-sectional study, 50 patients with pSS and 44 NHC were included. For all the participants, the forms of OAB-Validated 8-question Awareness Tool (OAB-V8) and 3-day voiding diary were completed. The diagnosis of OAB was made in the presence of OAB-V8 scores higher than 8. The 3-day means of the parameters in the voiding diary form were calculated and recorded. Results: The rate of OAB was found to be 56% in patients with pSS, while it was 22.7% in the NHC group. Comparing the pSS patients with the NHC group, significant differences were observed in terms of mean OAB-V8 score (11.5 ± 8.8 ; 6.5 ± 5.3 P < 0.05), daytime frequency (8.4 ± 3.7; 3.6 ± 2.6 P < 0.05) and nocturia (2.2 ± 1.24; 1.2 ± 1.1 P < 0.05). No incontinence was observed in any patients. Conclusion: OAB was encountered more frequently in pSS patients than in the NHC group. Since OAB is a treatable symptom complex, it should not be ignored, and symptoms of OAB should always be searched in pSS patients. doi: https://doi.org/10.4021/wjnu85w
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Solifenacin is an anticholinergic agent selective to M3 cholinergic receptor and has been widely used to treat overactive bladder (OAB). In this study, the efficacy and safety of solifenacin in patients with OAB were evaluated. A prospective study for evaluating the therapeutic results of solifenacin in patients with “OAB dry” (OAB without urge incontinence) or “OAB wet” (OAB with urge incontinence) was performed. Solifenacin 5 mg daily was given and the endpoint was set at the 6th month to evaluate the changes in urgency severity score (USS) after treatment. The measured parameters, including urinary frequency, nocturia, USS, maximum flow rate (Qmax), voided volume, post-voiding residual volume (PVR) and functional bladder capacity (FBC), were recorded at every visit. Patients were further categorized into OAB wet (USS, 4) and OAB dry (USS, 1, 2 and 3), and the effect and adverse events of solifenacin treatment were analyzed. A total of 54 patients was enrolled in this study and completed all follow-up visits. Significant improvements of USS, daytime urinary frequency and nocturia were noted in both OAB dry and OAB wet groups. The urinary frequency and nocturia episodes also improved significantly after taking solifenacin. Mean USS improved from 3.28 ± 0.94 to 2.02 ± 1.62 (p < 0.001), and Qmax increased significantly from 13.9 ± 8.9 mL/s to 15.8 ± 9.6 mL/s (p = 0.04) at baseline and 6 months, respectively. FBC and voiding volume were also found to have significant improvement; however, no significant change in PVR was noted from baseline to endpoint. The therapeutic efficacy showed no significant difference between the OAB dry and OAB wet groups. Minor adverse effects were noted in only seven patients (13.0%), and the most common complaint was difficult urination (5.6%). This study demonstrated that solifenacin is an effective antimuscarinic for treatment of OAB with few adverse effects. Patients with either OAB wet or OAB dry can benefit from solifenacin treatment, in terms of improvement in USS, frequency, nocturia episodes and bladder capacity, without compromising voiding efficiency. Only 13.0% of patients had minor adverse effect, typically dysuria.
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Objective: Overactive bladder (OAB) is a chronic medical condition that has a tremendous impact on the quality of life for both men and women. Urgency is a primary symptom in diagnosing OAB and is closely related to the urge to urinate frequently during the day. Material & Methods : A retrospective study was conducted from January 2018 until December 2020 by using medical records database in our institution. There were 562 patients. Inclusion criteria used in this study are patients with OAB symptoms with any etiology who have undergone conservative, moderate, or future or postoperative measures in the study period. The patient who cannot be cooperative in filling out the International Prostate Symptom Score (IPSS) questionnaire or the patient who refuses were excluded from this study. Statistical analysis was performed using Pearson correlation and linear regression. Results: From the results, linear regression, obtained significance (p <0.05) on the variables of frequency, urgency and nocturia. A linear regression value of y= -0.005 + 0.987X was obtained which illustrates that the higher the frequency, urgency and nocturia variables, the higher the possibility of Lower urinary tract symptoms (LUTS) that can be correlated with OAB. Conclusion: Frequency, nocturia, and urgency are factors that influence the significance of the IPSS variable on the total IPSS score. Questionnaire items on overactive bladder symptoms score (OABSS) have a significant correlation with IPSS scores.
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