Sacral magnetic stimulation effective in refractory stress incontinence

Aug 11 2014

By Joanna Lyford, Senior medwireNews Reporter

Sacral magnetic stimulation (SMS) may be an effective treatment for stress urinary incontinence in women whose symptoms are refractory to standard therapies, a clinical trial suggests.

Tien-Yow Chuang (Taipei Veterans General Hospital, Taiwan) and colleagues found that a short course of SMS resulted in a substantial improvement in women’s continence and quality of life, with benefits persisting for up to 4.5 months.

The strategy warrants further evaluation and refinement in order to optimise therapeutic outcomes, say the researchers writing in the Archives of Physical Medicine and Rehabilitation.

Chuang and fellow researchers recruited 40 women aged 45 to 75 years with a diagnosis of stress urinary incontinence, with or without detrusor overactivity. They were randomly assigned to receive SMS, administered using a coil-type stimulator over the third sacral roots for 20 minutes per day for 12 consecutive weekdays, or sham treatment.

SMS did not cause any adverse side effects, the authors report. Furthermore, women who received SMS showed significant improvements in measures of “life stress” between baseline and week 18.

Specifically, among women treated with SMS, mean scores on the Urge-Urinary Distress Inventory (Urge-UDI) questionnaire fell from 2.6 to 1.14, while scores on the Overactive Bladder Questionnaire 1 fell from 48.1 to 26.6. Both changes were statistically significant by week 6 and were sustained thereafter.

By contrast, women in the sham treatment group showed no change in these measures over the study period.

SMS was also associated with objective improvements in urodynamic parameters. Bladder capacity, urethral functional length and the ratio of pressure to transmission all increased significantly with SMS between baseline and follow-up. Again, these parameters were not improved in the sham group.

The team undertook a multivariate analysis to identify factors that predicted a response to therapy. They report that women with more severe symptoms benefited more from SMS; specifically, a higher Urge-UDI score and a shorter urethral functional length at baseline were associated with a greater post-SMS increase in maximal urethral closing pressure.

“Our observations of a greater response to SMS in patients with more severe SUI [stress urinary incontinence] than in those with mild symptoms, as well as the long-term benefits of the treatment, confirm the efficacy of SMS in treating SUI”, the team concludes.

They add: “Further investigation of the optimal stimulation parameters, maintenance protocol, and combined methods are required to optimize therapeutic outcomes.”

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