Radiofrequência transvaginal no tratamento da incontinência urinária : ensaio clínico randomizado

Abstract

Urinary Incontinence (UI) is defined as any involuntary loss of urine. It is an extremely prevalent clinical condition, with negative interference in quality of life. Can be classified as stress urinary incontinence (SUI), urge urinary incontinence (UUI) and mixed urinary incontinence (MUI). Pelvic floor muscle strengthening exercises and behavioral changes are the first line of treatment for UI. Drug or surgical therapy may be performed for SUI, which are not exempt from side effects and associated risks. In view of this, the search for therapeutics with minimally invasive potential, such as transvaginal radiofrequency (RF), is increasing. The aim of this study was to evaluate the effectiveness of using transvaginal radiofrequency in the treatment of UI, to improve satisfaction with urinary symptoms. A randomized clinical trial was conducted with post-menopausal women, with SUI or MUI. The participants were divided into two groups: control group (CG) and intervention group (IG). All received guidance on pelvic floor muscle strengthening exercises and behavioral guidelines. All were instructed to perform the pelvic floor muscle strengthening exercises at home, daily. The CG received the transvaginal radiofrequency transducer off. The IG received the transducer turned on. The groups were evaluated through sociodemographic and clinical questions, UI-related quality of life questionnaire (ICIQ-SF), three-day voiding diary and physical examination of the pelvic floor, all before and after intervention. The treatment was performed once a month for three months. The reevaluation occurred after 30 days from the end of treatment. 36 patients were randomized, 27 concluded the therapy, 15 in the control group and 12 in the intervention group. The study population had a mean age of 58,9±5,4 years, about half were married and 63,9% of the sample didn’t lose urine in the physical exam. The sociodemographic profile of the groups was evaluated before treatment and showed no statistical difference between the groups. Both groups showed an improvement in the ICIQ-SF score and a reduction in the number of SUI episodes in the voiding diary, after treatment, showed no statistical difference between them. The nocturia parameter, when assessed in isolation, showed significantly superior improvement only in the radiofrequency group (3,4±1,8 to 2,0±2,3; p<0,02). Our study found that transvaginal radiofrequency did not demonstrate superiority over conservative treatment for SUI symptoms. However, there was an improvement in nocturia symptoms in the group that used RF, and it can be a promising treatment, especially for the reduction of this symptom. This finding can be related to local tissue remodeling, secundary to treatment.