|A treatment protocol was initiated at the Department of
Urology of the School of Medicine of Botucatu. The patients were divided in two groups:
Group 1,10 patients with intrisic sphinter deficiency (urodynamic study exhibiting
abdominal leak point pressure (ALPP) < 60 cm H20 ) and Group 2, 12 patients
with genuine stress incontinence ( vesical neck hypermobility ). The group 1 aged 44-81
years old and average follow-up of 24 months and group 2 aged 46-71 years old and average
follow-up of 8 months. Selection criteria were based on clinical history, evaluation of
perineal musculature and urodynamic study. All patients presented urge incontinence, and
78% of these patients had previously undergone surgical repair for urinary incontinence in
group 1. 86% presented urge incontinence, and 50% of these patients had previously
undergone surgical repair for urinary incontinence in group 2. Although all the
above-mentioned patients felt uncomfortable due to their problem, they either refused to
undergo another surgery or did not present satisfactory clinical conditions that permitted
anesthesia without risks.
Patients with clinical history of urine loss with minimum efforts, deficit of perineal musculature and urodynamic study exhibiting abdominal leak point pressure (ALPP) lower than 60 cm H2 were subjected to Intravaginal Electrical Stimulation (IES) using an Innova pelvic floor electrical stimulation system (Empi) and physioterapy.
Treatment protocol consisted of 3 weekly sessions of electrostimulation during 14 weeks. During the first two weeks, 5-second stimuli were used with 10-second rest (5/10) for 15 minutes; during the third and fourth week, 5-second stimuli with 5-second rest (5/5) were used for 15 minutes; during the fifth and sixth week 5-second stimuli with 10-second rest (5/10) for 30 minutes. From the seventh week on, 5-second stimuli with 5-second rest were used (5/5) for 30 minutes until the fourteenth week. From the fifth week on, physiotherapy was initiated concurrent to IVS.
The exercises which increase abdominal pressure should be avoided in the beginning of the treatment, since they may cause urine loss and discourage the patient from continuing with the treatment. The above-mentioned exercises may be indicated when IVS has already shown results, usually after 7 weeks of treatment. It should also be mentioned that three series of 10 exercises should be performed daily by the patient at home. The combination of exercises performed at the hospital clinic and at home will yield good results.