Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women.

OBJECTIVE: To compare the effectiveness of an intensive group physical therapy program with individual biofeedback training for female patients with urinary stress incontinence. DESIGN: Randomized study of two therapeutic interventions consisting of a specific physical therapy program (PT) or biofeedback training (BF) daily for 4 wk, followed by a 2-mo, unsupervised home exercise program in both groups in an outpatient clinic of a large university hospital. Forty women, referred by gynecologists for nonoperative treatment of genuine stress incontinence of mild-to-moderate severity, were included. Measurements of daytime/nocturnal urinary frequency and subjective improvement of incontinence were the main outcome measures at initial presentation, after completion of the therapy program, and at follow-up after 3 mo. Standardized examinations of digital contraction strength, speculum tests, and manometric measurements were documented as secondary outcome measures. RESULTS: In the PT group, the daytime urination frequency decreased 22% after 4 wk of therapy and 19% after 3 mo (P < 0.05) from baseline. The nocturnal urination frequency was reduced by 66% after 4 wk of therapy and 62% after 3 mo (P < 0.001). In the BF group, the daily urination frequency decreased 10% after 4 wk of therapy and 5% after 3 mo (P > 0.05). The nocturnal urination frequency declined 36% after 4 wk of therapy and 66% after 3 months (P < 0.05). Subjective assessment after 3 mo showed that in the PT group, 28% of patients were free of incontinence episodes, 68% reported improved symptoms (incontinence episodes improved by >50%), and 4% were unchanged. In the BF group, 62% were free of incontinence episodes, and 38% were improved. Results of the digital contraction strength assessments, speculum tests, and manometric measurements showed statistically significant improvement in all variables in both groups after 3 months. CONCLUSION: Four weeks of both intensive group physical therapy or individual biofeedback training followed by an unsupervised home exercise program for 2 mo are effective therapies for female urinary stress incontinence and result in a significantly reduced nocturnal urinary frequency and improved subjective outcome. Only group physical therapy resulted in reduced daytime urinary frequency. BF therapy resulted in a better subjective outcome and higher contraction pressures of the pelvic floor muscles.

[Circulatory changes in local and segmental use of shortwave diathermy]. / Untersuchungen zur Durchblutungsänderung bei lokaler und segmentaler Anwendung der Kurzwelle.

6 healthy volunteers were examined for dose-effect relations, with a view to obtaining substantiated information for dosage in medical short-wave therapy. Venous occlusion plethysmography was used to measure total blood flow in the legs. So-called segmental treatment was checked, in addition to locally delimited high-frequency action. Low, medium, and high amounts of energy were therapeutically applied to the probands for 5, 10 and 20 minutes. Close correlations were found to exist between magnitude of blood flow, length of treatment and therapeutic intensity. The 20-minute variant proved to be the most effective application which differed from the literature according to which maximum intensification of blood flow was recorded at 10 minutes. The medium level of energy application was considered to be a highly favorable approach in terms of intensity. While higher doses usually provide the highest increase in blood flow, they may well cause discomfort. Blood flow remained increased after termination of therapy, usually for up to 60 minutes, in response to 20-minute medium-intensity short-wave treatment. Segmental high-frequency application likewise resulted in increased blood flow in both legs, though intensity values thus achieved were below results of locally delimited calf treatment.

Effects of continuous and pulsed microwave irradiation on distribution of heat in the gluteal region of minipigs. A comparative study.

Eleven experiments were conducted on minipigs for the purpose of determining heat distribution in tissue exposed to therapeutic doses of microwaves. Temperatures were measured by means of coated thermocouples from the cutis, subcutis, musculature, and periost. Irradiation was applied to intensities of 10 W, 40 W and 60 W by means of a "Radarmed 12 S 251" circular emitter and to 60 W, 100 W and 140 W, using a trough emitter. Maximum temperature in superficial tissue layers was reached after five to ten minutes of microwave exposure. The temperature rise in the cutis and subcutis was steeper and at a higher rate than that in the muscles. Continuation of microwave irradiation did not cause any further rise in temperature, which was attributed to induction of hyperaemia. No difference regarding heat distribution was found to exist between pulsed and continuous irradiation at equal wattage.