Effects and indications of sacral surface therapeutic electrical stimulation in refractory urinary incontinence

Abstract

Objective: To describe the effects and indications of sacral surface therapeutic electrical stimulation (SS-TES) for refractory urinary incontinence. Design: Evaluation before and after therapy. Setting: On clinical site and at nursing home. Subjects: Seven neurogenic bladder, five unstable bladder and six nocturia cases were investigated. Twelve were outpatients and six were residents. Interventions: Surface electrodes were placed at the posterior sacral foramens of S2 and S4. Stimulation conditions were duration 0.3 ms, frequency 20 Hz and maximum intensity. The stimulation was continued for 15 min twice daily for over one month. Main outcome measures: Therapeutic effects were evaluated on the basis of voiding charts as subjective findings and urodynamic study as objective findings before and after therapy. Results: Subjective findings showed incontinence frequency significantly decreased from 2.39±1.4 times/day before therapy to 1.39±2.0 times/day after therapy (p≤0.01); 55.5% of patients were improved or greatly improved. Objective findings showed that maximum vesical capacity (MVC) significantly increased from 208.29±94.5 ml before therapy to 282.19±66.8 ml (p≤0.001). Uninhibited contraction significantly decreased from 40.4±31.4 cmH2O before therapy to 25.79±23.9 cmH2O (p≤0.01); 44% of patients were improved or greatly improved. This therapy was effective in particular for cases whose MVC was small before applying SS-TES. Conclusion: SS-TES was effective in some patients with refractory urinary incontinence.