Eletroestimulação transcutânea do nervo tibial no tratamento da incontinência urinária de urgência em idosas : eficácia e seguimento

Abstract

Population aging is a reality in all over the world, and aging increases the chance of developing urinary incontinence in women, so it is important to study effective therapeutic strategies and non-invasive for this growing population. The objectives of this study were: review the literature available regarding electrical stimulation and urinary incontinence, and examine the short-and long-term efficacy of transcutaneous tibial nerve electrical stimulation for the treatment of urge urinary incontinence in elderly women. We performed: a systematic review and a randomized clinical trial with 101 older women (> 60 years) with urge incontinence, followed by a cohort study with 50 who had improved after the initial therapy. The systematic review included 30 randomized studies that reported good results for intravaginal electrical stimulation for urge urinary incontinence, tibial nerve electrical stimulation and sacral stimulation in patients refractory; other therapies require further data. The 101 participants were treated with 12 weeks of bladder retraining and pelvic floor muscles training , and 51 were randomly selected to also receive electrical stimulation. The cases were evaluated by 3-day voiding diary, the Kings Health Questionnaire (KHQ) (scale of quality of life related to incontinence), the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and clinical data. The study population had a mean age of 69 years, clinical characteristics, the frequency of urinary incontinence and quality of life before treatment were similar between groups. Both groups showed significant improvement in ICIQ-SF in most KHQ domains, and clinical parameters. However, there was significantly improvement in the group treated with electrostimulation in all domains of the KHQ and ICIQ-SF. Throughout the follow-up, patients who relapsed in the group with electrostimulation, had good results in the repetition of therapy. Electrical stimulation techniques require more randomized trials to establish the benefit of each one for urinary incontinence. Our study showed that the tibial nerve transcutaneous electrical stimulation is safe, effective and durable in elderly patients with urge urinary incontinence. It should be considered the first line therapy to this group of patients.