25 women that had
SUI were chosen; they were attended to, in the Sector of Urogynecology of the Gynecology
Clinic of the Clinical Hospital of the Medicine Faculty of the University of São Paulo
and the Perola Byington Hospital. The age varied from 28 to 40 years of age, and the age
media was of 34,72 years. 20 women were multiparous, with at least two normal births,
three referred to one normal birth, one had been submitted to two caesarean births and one
had no children. The parity media was of 2,32 births. All the patients were white, with a
weight that varied from 47 to 90 kg with a media of 66,28 kg.
The SUI diagnosis is based on the clinical history, on the urogynocological exam and the
urodynamic evaluation. Through the urogynocological exam, the degree of prolapse of the
anterior and posterior vaginal wall, according to the proposed classification by BADEN 7. 17 patients were
recorded as having anterior vaginal wall prolapse degree II, and eight degree I. Posterior
vaginal wall prolapse degree II was known in eight patients, and degree I in seven.
We did not include patients with: previous surgical treatment or clinical for SUI in the 6
months before the beginning of this study, drug users that act on the inferior urinary
tract, pregnant women, diabetes mellitus or chronicle obstructive pulmonary disease, with
anterior or posterior vaginal wall prolapse degrees III and IV 7 and/or uterine prolapse, with a uterine
cervix affection and/or vulvar, urinary tract infection, hyperactivity of the detrusor and
All the patients signed their post-informed consent.
The cones are devises of the same form and volume, made of stainless steel, covered with
plastic and having a nylon string at the apex to facilitate its removal. We used a set of
5 cones, numbered from 1 to 5, with weights of 20,0g; 32,5g; 45,0g; 57,5g and 70g,
respectively (Figure 1).
Figure 1 Vaginal Cones
The treatment was done in two phases: passive and
active. In the passive phase, in orthostatic position, the patient introduced the heaviest
weight cone that would result in a sensation of loss of the device, without loosing it, in
the absence of voluntary contraction of the pelvic floor. The apex of the cone should be
turned down, in direction of the pelvic floor. To identify this cone, she would introduce
the number 1 device. If there were no sensation of loss, she would pass on to number 2,
and so on. To follow we would orient the patient to walk, asking her not to contract the
musculature of the pelvic floor for a period of 1 minute, referring to the sensation of
loss of the device. Like this we could identify the initial passive cone.
The patient should keep this cone in her vagina walking for 15 minutes, twice a day, with
no voluntary contraction of the muscles of the pelvic floor. Starting from the moment that
she did not present a loss sensation; we would pass on to the next cone. This procedure
was maintained for 3 months.
The active phase would begin with the heaviest cone that the patient could retain in her
vagina, for a period of one minute with a voluntary contraction of the muscles of the
pelvic floor, in orthostatic position. To identify this device, called active cone, the
patient would begin introducing the device with the next largest weight than the one used
at the final passive phase. If she could keep it in her vagina, she would pass on to the
next weight, and so on. When a determined cone would appear through her vagina, the
patient would begin this phase with the last one. If the patient should finish the passive
phase with cone number 5, she should start the active phase with this same device.
After identifying the active cone, we would orient the patient to do 30 voluntary
contractions of five seconds, alternating with another five seconds of relaxation, twice a
day, also in an orthostatic position. When she was capable of keeping the cone in
position, we would pass on to the next weight. If she had no difficulty in keeping the
number 5 cone in her vagina before the end of this phase, the patient should end the
treatment with this same cone. In the same way as the passive phase, this was done in a
A clinical evaluation that included the analysis of the clinical complaint and the pad
test was done before and after each described phase. Urinary loss was evaluated
subjectively through the patients report about her clinical improvement, her
satisfaction with the treatment she received, and the need or not of another therapeutic
alternative. Following this evaluation, the patients were divided in groups, obeying the
following criteria: a) unaltered or aggravated; b) improved but, not satisfied with the
treatment, asking for another therapeutic alternative; c) improved, satisfied with the
treatment, not asking for another therapeutic alternative; d) cured.
The satisfaction with the treatment received and the need or not of another therapeutic
alternative were considered only at the end of the treatment.
The severity of urine loss was evaluated through the pad test of one hour, with a vesicle
volume of 50% maximum cystometric capacity and previous determined exercises in conformity
with the "International Continence Society".