Possibilities of combination treatment of urinary incontinence in women of different age groups

Abstract

The effectiveness of conservative therapy in patients with urinary incontinence depends on a variety of factors. There are no clinical guidelines for the use of pharmacological and non-pharmacological treatment concepts for women of reproductive and menopausal age. The aim of the study was evaluating the efficacy of various combinations of treatment for patients with urinary incontinence, based on electrical stimulation of the pelvic floor muscles with biofeedback, fractional photothermolysis with a CO2‑laser, and medications (antimuscarinics, selective β3‑agonist). The prospective randomized study included 105 patients, of whom 20 were of reproductive age and 85 were of menopausal age. The patients were divided into three groups: group 1 included the patients who underwent a course of electrical stimulation of the pelvic floor muscles and photothermolysis (with fractional CO2‑laser); in group 2, the patients received a combination of non-drug treatment and medications; in group 3, the patients receivedonly pharmacological treatment. In group 1, there were 7 patients of reproductive age and 28 menopausal patients, in group 2–5 and 30, and in group 3–8 and 27 patients, respectively. Results. The bladder diary scores improved significantly. Increasing the urinary flow rate was more effective with non-pharmacological treatment in young patients, and reducing the frequency of urination was more efficient with drug therapy in menopausal patients. The probability of achieving a urinary frequency of less than 8 times per day in the combination treatment group was 80 % higher than that in the non-drug treatment group and 62 % higher than that in the drug treatment group. The effectiveness of non-pharmacological therapy in increasing urinary flow rate is higher in patients of reproductive age. Pharmacological treatment is more effective for three months in menopausal women. The combination treatment is equally effective in patients aged 35 to 65 years and is superior in total effect to drug and non-drug treatment, with the effect maintaining for up to 6 months in menopausal patients.