Clinical efficacy and action mechanism of electrical pudendal nerve stimulation in treating female stress urinary incontinence / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the clinical efficacy and mechanism of electrical pudendal nerve stimulation (EPNS) in treating female stress urinary incontinence.Methods Thirty-five female patients with stress urinary incontinence were enrolled from May 2006 to April 2008.The average age was (54.9±9.7) years,the duration of incontinence was (74.1 ±45.6) months,the maximum urethral closure pressure was (63.7± 15.9) cm H2O,functional urethral length was (2.34±0.72) cm and bladder neck mobility was (1.23±0.76) cm.Long acupuncture needles were deeply inserted into four sacral points,which were located by the two edges of the sacrum on a level with the fourth sacral foramina and bilaterally to the tip of the coccyx.The needles were electrified (continuous waves,a frequency of 2.5 Hz,an intensity of 45-55 mA and 60 min once) to stimulate the pudendal nerves.When EPNS was performed,perineal ultrasonographic B-mode movements of the pelvic floor muscles (PFM),M-mode curves indicating the PFM contractions,vaginal pressure (VP) and PFM electromyogram were recorded simultaneously.Results When EPNS was performed correctly,the patient felt strong PFM contractions.Simultaneous records showed1)B-mode cranio-caudal PFM movements; 2) M-mode PFM movement curves (amplitudeabout 1 mm,n=31 ; in the other four patients,the M-mode curves were not obvious) ; 3) a sawtooth curve of VP changes (2.61±1.29 cm H2O,n=34); 4) PFM myoelectric waves (amplitude23.9±25.3 μV).If during the EPNS process the electric current was stopped or its intensity was reduced or the two lower needles were drawn back 1-2 cm,then the above ultrasonographic PFM movements and VP changes disappeared.In the 35 patients,the ICI-Q-SF score was 12.9±2.9 before treatment and decreased to 3.5±3.3 after 27.5± 11.9 sessions of treatment (P＜0.01).Twenty-five patients with ≥50％ symptom improvement at the end of treatment were followed up for 24-72 months (mean 50),and 19 cases had ≥ 50％ symptom improvement during the period of follow-up,including complete symptoms resolution in 10 cases.Conclusion EPNS can contract the PFMs and simulate PFM training to treat female stress incontinence.