Comparison of the effects of pelvic base muscle training, biofeedback and pretibial nerve stemulation treatments in patients with overall active bladder diagnosis: A randomized control

COMPARISON OF THE EFFECTS OF DIFFERENT TREATMENT METHODS ON LIFE QUALITY AND SEXUAL FUNCTIONS ON PATIENTS WITH EXTREMELY ACTIVE BLADDER DIAGNOSIS ABSTRACT Urinary incontinence is a condition that forces the patient and decreases the quality of life. ICS, AAM definition; accompained or not by congestion incontinence, generally increased frequency of urination during the day and also found the tightness associated with nocturia was identified as a syndrome. The overall prevalence rate of AAM among women is 16.9%. Conservative methods in the treatment of AAM are effective, well tolerated and safe treatment options. In our study, we aimed to determine the comparative efficacy of pelvic floor exercises, biofeedback therapy and pretibial nerve stimulation therapy in patients with overactive bladder syndrome. MATERIALS and METHODS Between June 2017 and March 2018, cases of urge incontinence were included in the study, which was referred to the Sakarya Training and Research Hospital (SEAH) Department of Obstetrics and Gynecology Urology Clinic for urinary incontinence. Between June 2017 and March 2018 patients reffered to the Sakarya Training and Research Hospital (SEAH) Department of Obstetrics and Urogynecology Clinic with urinary incontinence and cases which got diagnosis of urge incontinence included to the study. The mean age of the patients was 49.77 ± 9.47. Gynecologic and neurological examination, 3 day voiding diary, pads test, complete urine examination, urine culture, uroflowmetry, detailed history of the illness(using OAB V8, ICIQ SF, FSFI inquiry forms) were performed to the patients. Twelve of the 108 patients who were scheduled to be employed for treatment were terminated due to various reasons, and continued to work with 96 patients. Patients were randomized to 3 treatment groups by closed envelope method. The first group (n: 31) was treated with pelvic floor exercises, the second group (n: 32) pelvic floor exercises with biofeedback therapy and the third group (n: 33) with pelvic floor exercises with pretibial nerve stimulation for 12 weeks. At the end of 12 weeks, the questionnaire forms (OAB V8, ICIQ SF, FSFI) were reloaded to evaluate the patient's quality of life and urinary incontinence and the pelvic floor muscle strength was re-evaluated by digital vaginal palpation. RESULTS In our study, ICIQ-SF scores and OAB V8 scores were lower in all three groups than the pre-treatment scores (p <0.001). There was a significant decrease in the complaints of the patients in all three groups. In accordance with the literature, the mean pre-treatment ICIQ-SF score decreased in the PTE group from 16 to 9, in the BF + PTE group from 17,5 to 7, in the PTNS+ PTE from 17 to 9 after the treatment. Again in accordance with the literature, the mean pre-treatment OAB V8 score decreased in the PTE group from 30 to 12, in the BF + PTE group from 31 to 14, in the PTNS + PTE group from 36 to 16 after the treatment. As a result, the decrease in ICIQ-SF and OAB V8 levels after treatment was statistically significant in all three groups according to pre-treatment ICIQ-SF and OAB V8 levels. However, the change observed after treatment according to FSFI scores was not statistically significant (p> 0.05). There was no statistically significant difference between the groups in terms of urinary incontinence episodes after treatment (p> 0.05). However, the number of patients with complete cure / recovery was 11 (35.48%) in the pelvic exercise group (group 1), 18 (56.25%) in the pelvic floor exercise + biofeedback group (group2), pelvic floor exercise + pretibial nerve stimulation group (group3). 17 (51.51%). There was no statistically significant difference between the groups regarding PT (pad test) values after treatment (p> 0.05). However, the number of patients with complete dryness was 12 (38.7%) in the pelvic exercise group (group 1), 18 (56.25%) in the pelvic floor exercise + biofeedback group (group 2), pelvic floor exercise + pretibial nerve stimulation group (group3). 19 (57.57%). DISCUSSION and CONCLUSION Medical and conservative approaches are in the forefront in the treatment of AAM. Combined or separate uses may be preferred. When the literature is examined, it is observed that the use of conservative treatment methods in double-triple combinations gives more positive results. In ur study, we aimed to compare the superiority of these three current conservative methods and their efficacy in treatment in a randomized manner. We found that all three treatment groups were statistically effective in our evaluations before and after the treatment. When we compared the efficacy of three treatment groups with each other, there was no statistically significant difference between the groups. As a result, we believe that the individual approach will be appropriate when choosing UUI conservative treatment methods. As the effectiveness of treatments is similar, the individual characteristics, educational status and ease of follow-up are prominent when deciding on the treatment method. In the choice of treatment combination, the dominant symptoms and patient preference should be taken into consideration. KEYWORDS: Urge urinary incontinence, Pretibial nerve stimulation, Biofeedback, kegel exercise