E-ISSN: 2619-9467

Contents    Cover    Publication Date: 15 Dec 2023
Year 2023 - Volume 33 - Issue 4

Open Access

Peer Reviewed

368 Viewed485 Downloaded

Comparison of the Effectiveness of Pelvic Floor Muscle Training, Biofeedback, and Tibial Nerve Stimulation in Overactive Bladder Syndrome: A Prospective Randomized Controlled Study

Full Text PDF  
JCOG. 2023;33(4):236-44
DOI: 10.5336/jcog.2023-98743
Article Language: EN
Copyright Ⓒ 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Objective: It was aimed to comparatively assess the effectiveness of pelvic floor muscle training (PFMT), biofeedback (BF), and transcutaneous tibial nerve stimulation (TTNS) treatments in overactive bladder (OAB) patients. Material and Methods: The patients presented to the urogynecology outpatient clinic between June 2017 and March 2018. They were randomly divided into Group 1: PFMT (n=31), Group 2: PFMT and BF (n=32), and Group 3: PFMT and TTNS (n=33). Patients who received anticholinergic therapy, those who had a previous incontinence surgery or had neurological diseases, those who were pregnant, those who were breastfeeding, those with abnormal liver-kidney functions, persistent urinary infection, or atrophic vaginitis, and those who did not agree to take part in the study were excluded. The OAB Questionnaire (OAB-V8), the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and the Female Sexual Function Index forms were filled out before and after the 12-week treatment. Results: Daytime and nighttime urinary frequency, total urinary incontinence, and pad test values were lower after the treatment compared to before in all three groups (p<0.001). A statistically significant decline was seen in post-treatment ICIQSF and OAB-V8 scores compared to pre treatment scores in all three groups (p<0.01). The decrease in daytime urinary frequency was seen to be statistically significant in Group 2, and the values in this group were lower compared to those in Groups 1 and 3 (p: 0.045, p: 0.014, respectively). Conclusion: The overall effectiveness of the conservative treatments was determined to be similar. In the selection process, conservative treatment methods should be personalized.
  1. Leron E, Weintraub AY, Mastrolia SA, Schwarzman P. Overactive bladder syndrome: evaluation and management. Curr Urol. 2018;11(3):117-25. [Crossref]  [PubMed]  [PMC] 
  2. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al; International Urogynecological Association; International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4-20. [Crossref]  [PubMed] 
  3. Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327-36. [Crossref]  [PubMed] 
  4. Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. J Urol. 2019;202(3):558-63. [Crossref]  [PubMed] 
  5. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10):CD005654. [Crossref]  [PubMed]  [PMC] 
  6. Findlay JM, Yeung JM, Robinson R, Greaves H, Maxwell-Armstrong C. Peripheral neuromodulation via posterior tibial nerve stimulation - a potential treatment for faecal incontinence? Ann R Coll Surg Engl. 2010;92(5):385-90. [Crossref]  [PubMed]  [PMC] 
  7. Berghmans LC, Hendriks HJ, De Bie RA, van Waalwijk van Doorn ES, Bø K, van Kerrebroeck PE. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int. 2000;85(3):254-63. [Crossref]  [PubMed] 
  8. Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87(12):631-42. [Crossref] 
  9. Tarcan T, Mangır N, Özgür MÖ, Akbal C. OAB-V8 aşırı aktif mesane sorgulama formu validasyon çalışması [OAB-V8 overactive bladder questionnaire validation study]. Üroloji Bülteni. 2012;21(21):113-6. [Link] 
  10. Çetinel B, Özkan B, Can G. ICIQ-SF Türkçe versiyonu validasyon (geçerlilik) çalışması [The validation study of ICIQ-SF Turkish version]. Turk J Urol. 2004;30(3):332-8. [Link] 
  11. Aydın S, Onaran ÖI, Topalan K, Aydın ÇA, Dansuk R. Development and validation of Turkish version of the Female Sexual Distress Scale-revised. Sex Med. 2016;4(1):e43-50. [Crossref]  [PubMed]  [PMC] 
  12. Kopańska M, Torices S, Czech J, Koziara W, Toborek M, Dobrek Ł. Urinary incontinence in women: biofeedback as an innovative treatment method. Ther Adv Urol. 2020;12:1756287220934359. [Crossref]  [PubMed]  [PMC] 
  13. Firinci S, Yildiz N, Alkan H, Aybek Z. Which combination is most effective in women with idiopathic overactive bladder, including bladder training, biofeedback, and electrical stimulation? A prospective randomized controlled trial. Neurourol Urodyn. 2020;39(8):2498-508. [Crossref]  [PubMed] 
  14. Wang AC, Wang YY, Chen MC. Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder. Urology. 2004;63(1):61-6. [Crossref]  [PubMed] 
  15. Aukee P, Immonen P, Laaksonen DE, Laippala P, Penttinen J, Airaksinen O. The effect of home biofeedback training on stress incontinence. Acta Obstet Gynecol Scand. 2004;83(10):973-7. [Crossref]  [PubMed] 
  16. Sung MS, Hong JY, Choi YH, Baik SH, Yoon H. FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence. J Korean Med Sci. 2000;15(3):303-8. [Crossref]  [PubMed]  [PMC] 
  17. Schmidt AP, Sanches PR, Silva DP Jr, Ramos JG, Nohama P. A new pelvic muscle trainer for the treatment of urinary incontinence. Int J Gynaecol Obstet. 2009;105(3):218-22. [Crossref]  [PubMed] 
  18. Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002;288(18):2293-9. [Crossref]  [PubMed] 
  19. Voorham JC, De Wachter S, Van den Bos TWL, Putter H, Lycklama À Nijeholt GA, et al. The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: a randomized controlled trial. Neurourol Urodyn. 2017;36(7):1796-803. [Crossref]  [PubMed] 
  20. Scaldazza CV, Morosetti C, Giampieretti R, Lorenzetti R, Baroni M. Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study. Int Braz J Urol. 2017;43(1):121-6. [Crossref]  [PubMed]  [PMC] 
  21. Waldinger MD, Schweitzer DH. Persistent genital arousal disorder in 18 Dutch women: Part II. A syndrome clustered with restless legs and overactive bladder. J Sex Med. 2009;6(2):482-97. [Crossref]  [PubMed] 
  22. van Balken MR, Vergunst H, Bemelmans BL. Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation. Int J Impot Res. 2006;18(5):470-5 [Crossref]  [PubMed] 
  23. Schreiner L, dos Santos TG, Knorst MR, da Silva Filho IG. Randomized trial of transcutaneous tibial nerve stimulation to treat urge urinary incontinence in older women. Int Urogynecol J. 2010;21(9):1065-70. [Crossref]  [PubMed] 
  24. Biemans JM, van Balken MR. Efficacy and effectiveness of percutaneous tibial nerve stimulation in the treatment of pelvic organ disorders: a systematic review. Neuromodulation. 2013;16(1):25-33; discussion 33. [Crossref]  [PubMed] 
  25. Peters KM, Carrico DJ, Wooldridge LS, Miller CJ, MacDiarmid SA. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J Urol. 2013;189(6):2194-201. [Crossref]  [PubMed]