Abstract
Background
Electrical stimulation with non-implanted devices is used for patients with different types of urinary incontinence and symptoms of urgency, frequency and nocturia. The current review focused on electrical stimulation with non-implanted devices for the treatment of urinary incontinence in men.
Objectives
To determine the effectiveness of electrical stimulation with non-implanted devices for men with stress, urgency or mixed urinary incontinence in comparison with no treatment, placebo treatment, or any other ‘single’ treatment. Additionally, the effectiveness of electrical stimulation with non-implanted devices in combination with another intervention was compared with the other intervention alone. Finally, the effectiveness of one method of electrical stimulation with non-implanted devices was compared with another method.
Search methods
We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PreMEDLINE, and handsearching of journals and conference proceedings (searched 21 January 2012). We also searched other electronic and non-electronic bibliographic databases and the reference lists of the included studies as well as contacting researchers in the field to identify other relevant trials.
Selection criteria
Randomized and quasi-randomized controlled trials.
Data collection and analysis
Two review authors independently assessed all the identified trials for eligibility. Risk of bias was assessed using the Cochrane tool for determining bias. Disagreements were resolved by discussion, and a third review author was involved in the case of no consensus. Data were analysed using Cochrane methods.
Main results
Six randomized controlled trials (five full papers and one abstract) were included. There was considerable variation in the interventions used, study protocols, types of electrical stimulation parameters and devices, study populations and outcome measures. In total 544 men were included, of whom 305 received some form of electrical stimulation, and 239 a control or comparator treatment. The trials were mostly small and generally there was not sufficient information to assess risk of bias; only two trials used secure methods of randomization.
There was some evidence that electrical stimulation (ES) had a short-term effect in reducing incontinence compared with sham treatment (for example risk ratio (RR) at six months 0.38, 95% CI 0.16 to 0.87) but not at 12 months. Four trials evaluated the effect of adding PFMT to ES versus pelvic floor muscle training (PFMT) alone or with biofeedback. There was no evidence of a statistically significant difference in the number of men with urinary incontinence at three months (146/239, 61% for combined treatment versus 98/156, 63% with PFMT alone; RR 0.93, 95% CI 0.82 to 1.06). However, there were more adverse effects with combined treatment (23/139, 17% versus 2/99, 2% with PFMT alone; RR 7.04, 95% CI 1.51 to 32.94) and quality of life also seemed better with PFMT alone. One small trial did not detect statistically significant differences between two methods of administration of transcutaneous electrical stimulation (anal versus perineal) but the quality of life score was lower (better) in the anal stimulation group.
Authors’ conclusions
There was some evidence that electrical stimulation enhanced the effect of PFMT in the short term but not after six months. There were, however, more adverse effects (pain or discomfort) with electrical stimulation.
Plain language summary
Electrical stimulation with non-implanted electrodes for urinary incontinence in men
Some men leak urine (urinary incontinence) when they cough or exercise (stress urinary incontinence) or when they have a sudden, compelling urge to pass urine (urgency urinary incontinence). Men may also need to pass urine more often than usual (frequency) or get up more than once at night to pass urine (nocturia). In men this may be due to an enlarged prostate gland or develop after surgery to removal the prostate. Men can contract their pelvic floor muscles to reduce or stop these symptoms. Electrical stimulation with non-implanted devices involves stimulation of these muscles with a painless electric current using surface electrodes on the skin or a probe placed into the anus. The aim is to make the pelvic floor muscles contract so that they become stronger and so better able to prevent leakage, or to make the muscle at the base of the bladder (the sphincter) contract more strongly to stop urine escaping. Electrical stimulation might also lessen the contractions of the bladder muscle to ease the sense of urgency and allow the bladder to hold more urine.
In this review, electrical stimulation was compared with no treatment, placebo treatment (dummy medical treatment) or any other single treatment. There was some evidence that electrical stimulation increased the effect of pelvic floor muscle training (exercises to strengthen the pelvic floor muscles) in the short term but not after six months. It was not possible to identify whether one treatment was more successful than another. There was, however, more discomfort or pain (adverse effects) with electrical stimulation than with pelvic floor muscle exercises alone. There was not enough information about whether and how electrical stimulation should be used, which type of person or problem it would be best for, and how much it would cost.
