Long-term sacral magnetic stimulation for refractory stress urinary incontinence

Po-Yi Tsai; Chih-Pin Wang; Chin-Yi Hsieh; Yun-An Tsai; Shih-Ching Yeh; Tien-Yow Chuang

doi:10.1016/j.apmr.2014.07.010

Long-term sacral magnetic stimulation for refractory stress urinary incontinence

Arch Phys Med Rehabil. 2014 Dec;95(12):2231-8. doi: 10.1016/j.apmr.2014.07.010. Epub 2014 Jul 27.

Authors

Po-Yi Tsai¹, Chih-Pin Wang², Chin-Yi Hsieh², Yun-An Tsai³, Shih-Ching Yeh⁴, Tien-Yow Chuang⁵

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
² Department of Emergency, Mackay Memorial Hospital, Taipei, Taiwan.
³ Neural Regeneration Laboratory, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan.
⁵ Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: tychuang@vghtpe.gov.tw.

PMID: 25073008
DOI: 10.1016/j.apmr.2014.07.010

Abstract

Objective: To evaluate the effects of sacral magnetic stimulation (SMS) on functional and urodynamic improvement in patients with refractory stress urinary incontinence (SUI).

Design: A sham-controlled, double-blind, parallel study design with a 4.5-month follow-up.

Setting: A tertiary hospital.

Participants: Women (age, 45-75y) with SUI refractory to first-line management (N=34) were allocated to either an experimental (n=20) group or a sham (n=14) group.

Interventions: The SMS protocol consisted of 5-Hz, 20-minute treatments administered over the bilateral third sacral roots, with the intensity set at approximately 70% of the maximal output, for 12 consecutive weekdays.

Main outcome measures: Urodynamic assessments and 2 life stress questionnaires, namely, the Urge-Urinary Distress Inventory (U-UDI) and the Overactive Bladder Questionnaire (OAB-q), were administered pre- and post-SMS intervention. We administered the U-UDI (primary outcome measure) and the OAB-q at 3-week intervals during the follow-up period until 18 weeks after the final intervention.

Results: The experimental group exhibited significant improvements in both U-UDI and OAB-q scores postintervention (P=.011-.014) and at follow-up visits (P<.001-.007) compared with the sham group. In addition, significant increases in bladder capacity, urethral functional length, and the pressure transmission ratio (P=.009-.033) were noted postintervention. Multivariate regression analysis revealed that patients with more severe symptoms benefited more from SMS. A poorer baseline U-UDI score and a shorter urethral functional length were associated with a greater response to SMS.

Conclusions: Our observations of a greater response to SMS in patients with more severe SUI than in those with mild symptoms, as well as the long-term benefits of the treatment, confirm the efficacy of SMS in treating SUI.

Trial registration: ClinicalTrials.gov NCT02091947.

Keywords: Magnetic stimulation therapy; Quality of life; Rehabilitation; Treatment; Urinary incontinence; Urodynamics.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Double-Blind Method
Female
Humans
Magnetic Field Therapy*
Middle Aged
Quality of Life / psychology*
Sacrococcygeal Region
Severity of Illness Index
Spinal Nerve Roots
Surveys and Questionnaires
Urinary Incontinence, Stress / physiopathology
Urinary Incontinence, Stress / psychology
Urinary Incontinence, Stress / rehabilitation*
Urodynamics*

Associated data

ClinicalTrials.gov/NCT02091947