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A COMPARATIVE
STUDY OF MAGNETIC VERSUS ELECTRICAL STIMULATION ON INHIBITION OF
DETRUSOR OVERACTIVITY
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Authors:
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M Yano, T Yamanishi,
K Yasuda, R Sakakibara, T Uchiyama, S Suda, T Hattori, S Kitahara
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Institution:
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Department of Urology,
Dokkyo University, School of Medicine, Koshigaya Hospital, Saitama,
Japan, and Departments of Urology and Neurology, Chiba University,
School of Medicine, Chiba
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Aims of
study:
Functional pelvic floor electrical stimulation (FES) has been utilized as a
treatment for urinary incontinence due to overactive bladder. Functional magnetic
stimulation (FMS) has been applied by clinical neurophysiologists as a safe
and noninvasive method for stimulation of nervous tissues(1). Recently, a continuous
magnetic stimulator assuring long-time stimulation has been developed, and the
effects on urethral closure and inhibition of detrusor contraction have been
reported(2,3). The aims of our study was to perform a randomized study for investigating
the urodynamic effects of FMS and FES on inhibition of detrusor overactivity.
Methods:
Thirty-two patients with urinary incontinence due to detrusor instability (15
males, 17 females; aged 62.3 ± 16.6 years) were randomly assigned to two treatment
groups (15 patients in the FMS group and 17 in the FES group). Stimulation was
applied continuously at 10 Hz in both groups. For FMS the magnetic stimulator
unit was set on an arm-chair type seat and had a built-in coil-cooling system
and a concave-shaped coil, so that the patients could sit undressed during stimulation.
For FES, a vaginal electrode was used in females and an surface electrode to
the foreskin of the penis in males. Cystometry was performed before and during
the stimulation.
Results:
The two treatment groups were well matched with each other in terms of number
of patients, age, sex, body weight and pre-treatment urodynamic parameters.
Bladder capacity at first desire to void and and maximum cystometric capacity
increased significantly during stimulation compared with prestimulation levels
in both groups (p= 0.0054 and 0.0015, respectively, in the FMS group, and p=
0.0045 and 0.0229, respectively, in the FES group). However, the increase in
maximum cystometric capacity was significantly (p=0.0135) greater in the FMS
group (114.2±124.1 cmH2O, or 105.5±130.4% increase compared with pretreatment
level) than that in the FES group (32.3±56.6 cmH2O, or 16.3±33.9% increase).
Detrusor overactivity was abolished in 3 patients of the FMS group, but not
in any patient of the FES group. No adverse effects were noted in any of the
patients of both groups during the stimulation.
Conclusions:
Although both treatments were effective, inhibition of detrusor overactivity
appeared greater in the FMS group than in the FES group.
References:
1.Neurosurgery 20: 100-109, 1987.
2.Urology 53: 1108-1111,1999.
3.Urology 54:652-655,1999.