Urinary Incontinence

J Physiol Pharmacol.  2012 Sep;63(4):397-401.

Pulsating electromagnetic field stimulation of urothelial cells induces apoptosis and diminishes necrosis: new insight to magnetic therapy in urology.

Juszczak K, Kaszuba-Zwoinska J, Thor PJ.

Source

Department of Pathophysiology, Jagiellonian University, Medical College, Cracow, Poland. kajus13@poczta.onet.pl.

Abstract

The evidence of electromagnetic therapy (EMT) efficacy in stress and/or urge urinary incontinence, as well as in detrusor overactivity is generally lacking in the literature. The potential EMT action of neuromuscular tissue depolarization has been described. Because there is no data on the influence of pulsating electromagnetic fields (PEMF) on the urothelium, we evaluated the effect of PEMF stimulation on rat urothelial cultured cells (RUCC). In our study 15 Wistar rats were used for RUCC preparation. RUCC were exposed to PEMF (50 Hz, 45±5 mT) three times for 4 hours each with 24-hour intervals. The unexposed RUCC was in the same incubator, but in a distance of 35 cm from the PEMF generator. Annexin V-APC (AnV+) labelled was used to determine the percentage of apoptotic cells and propidium iodide (PI+), as standard flow cytometric viability probe to distinguish necrotic cells from viable ones. The results are presented in percentage values. The flow cytometric analysis was carried out on a FACS calibur flow cytometer using Cell-Quest software. In PEMF-unstimulated RUCC, the percentage of AnV+, PI+, and AnV+PI+ positive cells were 1.24±0.34%, 11.03±1.55%, and 12.43±1.96%, respectively. The percentages of AnV+, PI+, and AnV+PI+ positive cells obtained after PEMF stimulation were 1.45±0.16% (p=0.027), 7.03±1.76% (p<0.001), and 9.48±3.40% (p=0.003), respectively. The PEMF stimulation of RUCC induces apoptosis (increase of AnV+ cells) and inhibits necrosis (decrease of PI+ cells) of urothelial cells. This leads us to the conclusion that a low-frequency pulsating electromagnetic field stimulation induces apoptosis and diminishes necrosis of rat urothelial cells in culture.

Arch Gynecol Obstet. 2010 Jul;282(1):49-53. Epub 2009 Oct 16.

Long-term effects of extracorporeal magnetic innervations in the treatment of women with urinary incontinence: results of 3-year follow-up.

Do?anay M, Kilic S, Yilmaz N.

Department of Obstetrics and Gynecology, Zekai Tahir Burak Mother Health Training and Research Hospital, Ankara, Turkey. drmdoganay@gmail.com

Abstract

PURPOSE: This study is designed to evaluate the long-term efficacy of extracorporeal magnetic innervation (ExMI) in the treatment of women with urinary incontinence.

METHODS: Our prospective study included a period of 3 years between May 2005 and October 2008. A total of 137 consequent women with stress and urge incontinence were included in the study. Of the patients, 68 had stress incontinence and others had urge incontinence.

RESULTS: All of the patients with stress incontinence were successfully followed up and 32 (47%) were totally dry in negative stress test at the 6 months after ExMI therapy. In the same group, 27(39%) showed improvement in the frequency of daily leak episodes from 3.2 times to 1.2 times. In the urge incontinence group, all of the patients completed the treatment and they were successfully followed up. While 40 (58%) patients were dry and 18 (26%) significantly improved the average number of incontinence episodes decreased from 3.7 times to 1.7 times per day, treatment failed in the remaining 11 (16%) patients at the 6 months. At 6 months, the recurrence rate was 53%.

CONCLUSIONS: At the 6 months after 16 sessions of ExMI had a significant QOL, parallel to decrease in daily pad use and leakage episodes. Only 16 sessions are not effective definitive therapy. The beneficial effects are temporary and there is high recurrence.

BJU Int. 2009 May;103(10):1386-90. Epub 2009 Jan 14.

A double-blind randomized controlled trial of electromagnetic stimulation of the pelvic floor vs sham therapy in the treatment of women with stress urinary incontinence.

Gilling PJ, Wilson LC, Westenberg AM, McAllister WJ, Kennett KM, Frampton CM, Bell DF, Wrigley PM, Fraundorfer MR.

Departments of Urology and Physiotherapy, Tauranga Hospital, Tauranga, New Zealand.

Abstract

OBJECTIVE: To compare the efficacy of extracorporeal electromagnetic stimulation (ES) of the pelvic floor for treating stress urinary incontinence (SUI) vs sham ES.

PATIENTS AND METHODS: In all, 70 women with urodynamically confirmed SUI were randomized to receive active (35) or sham (35) ES. The NeoControl chair (NeoTonus, Marietta, GA, USA) was used, and treatment consisted of three sessions per week for 6 weeks. data were collected before and after treatment on all women, including a 20-min provocative pad-test with a predetermined bladder volume (primary outcome measure), a 3-day bladder diary and 24 h pad-test. Circumvaginal muscle (CVM) rating score, perineometry using two separate instruments and video-urodynamics were also used, and the Urinary Incontinence Quality of Life Scale (I-QOL) and King’s Health Questionnaires. Patients were fully re-evaluated 8 weeks after treatment, and the bladder diary, pad-test and questionnaires were repeated at 6 months. The urotherapist and physician were unaware to which treatment group the patient was assigned.

RESULTS: In the overall group of 70 patients there were significant improvements in each of the primary and secondary outcome measures at 8 weeks. There were also significant improvements in primary and secondary outcome measures in the active treatment group when compared with baseline measures. At 8 weeks, there were improvements in the mean (sd) values for the 20-min pad-test, of 39.5 (5.1) vs 19.4 (4.6) g (P < 0.001); the 24-h pad-test, of 24.0 (4.7) vs 10.1 (3.1) g (P < 0.01); the number of pads/day, of 0.9 (0.1) vs 0.6 (0.1) (P < 0.01), the I-QOL score, of 63.7 (2.8) vs 71.2 (3.3) (P < 0.001); and King’s Health Questionnaire score, of 9.6 (0.8) vs 6.9 (0.7) (P < 0.001). However, these improvements were not statistically significant when compared with the sham-treatment group. In those patients on active treatment who had a poor pelvic floor contraction at the initial assessment (defined by the CVM score and perineometry), there was a significant reduction (P < 0.05) in the 20-min pad-test leakage when compared with the sham-treatment group.

CONCLUSIONS: ES was no more effective overall than sham treatment in this patient group. However, in those women who were unable to generate adequate pelvic floor muscle contractions, there was an objective improvement in provocative pad testing when compared to sham treatment.

Urol Int. 2008;81(2):167-72. Epub 2008 Aug 29.

Extracorporeal magnetic innervation for the treatment of stress urinary incontinence: results of two-year follow-up.

Ho?can MB, Dilmen C, Perk H, Soyupek S, Arma?an A, Tükel O, Ekinci M.

Department of Urology, Alanya Medical Center, Ba?ent University, Antalya, Turkey. drburakhoscan@yahoo.com

Abstract

INTRODUCTION: Extracorporeal magnetic innervation (ExMI) is a relatively new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We aimed to evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress urinary incontinence.

MATERIALS AND METHODS: A total of 30 patients with demonstrable stress urinary incontinence were enrolled in this study. All were neurologically normal with normal urinalysis and none was pregnant. Evaluation before treatment included 3-day bladder diaries, a dynamic pad weight test, urodynamics, and a validated quality of life survey. Treatment sessions lasted 20 min, twice a week, for 6 weeks. After ExMI, all measures were repeated at follow-up including 3-day bladder diary, dynamic pad weight test, urodynamics and quality of life survey. The follow-up was done at 3, 12 and 24 months after ExMI therapy but urodynamics were performed only at first follow-up.

RESULTS: After ExMI therapy, 8 out of the 27 patients were cured (29.7%) and 13 patients were improved (48.1%) at 3 months. The cumulative success rate was 77.8%. Six patients did not show any improvement after treatment. Pad weight was reduced from 14.4 +/- 10.7 to 6.5 +/- 5.1 g. The mean score of quality of life survey at baseline was 61.6 and this increased to 75.4 at 12 weeks. The effect of ExMI approximately continued until the 1st year after therapy but gradually decreased and came close to baseline at the 2nd year after therapy.

CONCLUSION: As a result, ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI also offers a noninvasive, effective and painless treatment for women with stress urinary incontinence. Further studies are needed to address how long the therapy will continue and benefits will last and whether retreatment or continuation therapy sessions will be necessary.

Scand J Urol Nephrol. 2008;42(5):433-6.

Extracorporeal magnetic innervation therapy: assessment of clinical efficacy in relation to urodynamic parameters.

Groenendijk PM, Halilovic M, Chandi DD, Heesakkers JP, Voorham-Van Der Zalm PJ, Lycklama Anijeholt AA.

Department of Urology, Reinier de Graaf Group, Delft, The Netherlands. groenenp@rdgg.nl

Abstract

OBJECTIVE: Clinical efficacy and urodynamic changes in women treated by extracorporeal magnetic innervation therapy (ExMI) were studied.

MATERIAL AND METHODS: Women, presenting with urge, stress and mixed urinary incontinence, were included in a prospective study. ExMI was applied by an electromagnetic chair. To document clinical efficacy, a voiding diary and visual analogue scale were completed before and after treatment, together with a pad test. Detrusor overactivity (DO) and urethral instability (URI) were urodynamically documented. Clinical success was defined as more than 50% improvement in symptoms.

RESULTS: Sixteen patients were included. At baseline, DO was observed in 10 patients, and URI in 12 patients. DO did disappear at follow-up in 60%, and a decrease in URI was seen in 66%. No significant clinical improvement was seen at follow-up.

CONCLUSION: Although significant changes in urodynamic variables were observed, no significant improvement in clinical efficacy was seen after ExMI.

Eur Urol. 2007 Sep;52(3):876-81. Epub 2007 Feb 20.

Extracorporeal magnetic stimulation is of limited clinical benefit to women with idiopathic detrusor overactivity: a randomized sham controlled trial.

Morris AR, O’Sullivan R, Dunkley P, Moore KH.

The Pelvic Floor Unit, St George Hospital, Kogarah, NSW 2217, Australia.

Abstract

OBJECTIVES: To observe the effect of both acute and medium-term magnetic stimulation of the pelvic floor on detrusor function amongst women with idiopathic detrusor overactivity (IDO).

METHODS: Two separate studies were undertaken amongst women with a sole diagnosis of IDO. The first study assessed the acute effect of magnetic stimulation (provided by Neocontrol ) on detrusor function during the filling phase of standard cystometry. Multiple filling cycles were performed with stimulation at a different key moment in each. This was done to establish that the device could influence the detrusor. Subsequently, a randomized sham control trial was performed to assess clinical efficacy. A total of 20 treatments, each of 20 minutes duration, were administered over six weeks with follow-up six weeks thereafter. Half the patients received therapy from a genuine device, the others receiving fake treatment on an identical looking/sounding sham device. The sham device contained a deflector plate to degrade the magnetic field and was located in a separate room. Outcome measures included changes in a 24 hour fluid volume chart, urine loss (24 hour pad test) and quality of life instruments.

RESULTS: Amongst 10 patients receiving stimulation during cystometry, volume at first involuntary detrusor contraction during filling rose from a median value of 240ml (Inter-quartile range (IQR) 210-300) to 285ml (IQR 231-320), p = 0.03 and maximum detrusor pressure decreased from 40cm water (IQR 34-45) to 33cm water (IQR 25-41), p<0.01. The RCT was completed by 29 of 44 (66%) recruits. Of these, 15 of 29 (52%) received active treatment and 14 of 29 (48%) sham therapy. Active therapy significantly reduced the number of urge episodes per day, p<0.01. With respect to baseline, actively treated patients experienced significant reduction in voids per day and quality of life but this trend did not reach significance when compared to the sham group, partly due to unexpected difficulty in recruitment which yielded an underpowered sample size for these outcome measures.

CONCLUSIONS: Magnetic stimulation reduces detrusor contractility in the acute phase of administration. Although the treatment was well tolerated and urge episodes reduced following prolonged therapy, no statistically significant improvement was observed in quality of life indices or measured 24 hour urinary loss. The treatment cannot be recommended for women with IDO.

BJU Int. 2006 May;97(5):1035-8.

Effects of magnetic stimulation in the treatment of pelvic floor dysfunction.

Voorham-van der Zalm PJ, Pelger RC, Stiggelbout AM, Elzevier HW, Lycklama à Nijeholt GA.

Department of Urology, Leiden University Medical Center, the Netherlands. pjvoorham@lumc.nl

Abstract

OBJECTIVE: To correlate, in a pilot study, the clinical results of extracorporeal magnetic innervation therapy (ExMI) of the pelvic floor muscles with functional changes in the pelvic floor musculature, urodynamics and quality of life.

PATIENTS AND METHODS: In all, 74 patients (65 women and nine men) with urge incontinence, urgency/frequency, stress incontinence, mixed incontinence and defecation problems were included in a prospective study of ExMI using a ‘electromagnetic chair’. All patients were treated twice weekly for 8 weeks. Digital palpation and biofeedback with a vaginal or anal probe were used for registration of the pelvic floor musculature. A urodynamic evaluation, a voiding diary, a pad-test, the King’s Health Questionnaire (KHQ) and a visual analogue scale (VAS) were completed by the patient at baseline and at the end of the study.

RESULTS: In the group as a whole, there were no significant differences in the voiding diary, pad-test, quality of life, VAS score, biofeedback registration and urodynamics before and after treatment. Additional stratification was applied to the total patient group, related to the pretreatment rest tone of the pelvic floor, the basal amplitude registered on electromyography, to age and to previous treatments. However, there were no significant differences in the data before and after treatment within all subgroups (stress incontinence, urge incontinence, urgency/frequency, defecation problems, overactive pelvic floor, age, previous treatments), except for the KHQ domain of ‘role limitations’, where there was a significant improvement in all groups.

CONCLUSION: ExMI did not change pelvic floor function in the present patients. The varying outcomes of several studies on ExMI stress the need for critical studies on the effect and the mode of action of electrostimulation and magnetic stimulation. In our opinion ‘the chair’ is suitable to train awareness of the location of the pelvic floor. However, active pelvic floor muscle exercises remain essential.

Curr Opin Urol. 2005 Jul;15(4):231-5.

A critical review on magnetic stimulation: what is its role in the management of pelvic floor disorders?

Quek P.

Department of Urology, Changi General Hospital, Singapore 529889. pharoahpug@yahoo.co.uk

Abstract

PURPOSE OF REVIEW: This review looks at the acute effects of magnetic stimulation on urodynamic parameters and reviews the data on its use in the management of urinary incontinence.

RECENT FINDINGS: Reported cure rates for stress incontinence immediately after a course of perineal magnetic stimulation range from 12.5 to 52.9% with good improvement occurring in 32% to 41%. However the effect seems temporary and dependent on the number of sessions. Sacral and pelvic floor magnetic stimulation have also been shown to increase cystometric capacity, inhibit detrusor overactivity and resolve overactive bladder symptoms acutely. Persistence of this effect with symptomatic improvement one week after sacral magnetic stimulation has been demonstrated. How magnetic stimulation suppresses detrusor contraction is not known. Prospective trials with the Neocontrol chair (Neotonus Inc, Marietta, Georgia, USA) also showed symptomatic improvement in 71 to 87% in the short term. However, the longer term data appear mixed.

SUMMARY: Overall, the data available vary too much in terms of treatment protocols, patient mix and symptom severity to determine which group of patients might benefit most and what the optimal stimulation parameters are for each condition. Mean reductions in leak parameters, although statistically significant, may not always be clinically satisfactory. The beneficial effects also appear to be temporary and continuous treatment will probably be required. Further trials are needed to determine the optimum stimulation protocols for different situations and to compare magnetic stimulation with other forms of conservative pelvic floor therapy.

Urol Int. 2005;74(3):224-8.

Preliminary results of the effect of extracorporeal magnetic stimulation on urinary incontinence after radical prostatectomy: a pilot study.

Yokoyama T, Inoue M, Fujita O, Nozaki K, Nose H, Kumon H.

Department of Urology, Okayama University Graduate School of Medicine and Dentistry, Okayama 700-8558, Japan. uroyoko@md.okayama-u.ac.jp

Abstract

INTRODUCTION: Radical prostatectomy is a common procedure for the treatment of clinically localized prostate cancer. However, urinary incontinence is a significant potential source of morbidity following surgery. Extracorporeal magnetic stimulation (ExMS) is a new technology used for pelvic muscle strengthening in the treatment of stress urinary incontinence. We investigated the clinical effects of ExMS on urinary incontinence after retropubic radical prostatectomy.

PATIENTS AND METHODS: Ten patients who had suffered from urinary incontinence for more than 12 months following radical prostatectomy were enrolled in this study. The Neocontrol system was used. Treatment sessions were for 20 min, twice a week for 2 months. The frequency of the pulse field was 10 Hz for 10 min, followed by a second treatment at 50 Hz for 10 min. Objective and subjective measures included voiding diaries, 1-hour pad weight testing, and a quality of life survey at 1, 2, 3, and 6 months after starting the treatment. Urodynamic studies were performed before and after treatment.

RESULTS: Three patients became dry (30%), 3 patients improved (30%), and 4 patients showed stationary symptoms (40%). In the 1-hour pad weight testing, the mean pad weight decreased from 25 to 10.3 g, and the quality of life scores had improved from 70.5 to 84.9 2 months after treatment. The frequency of leak episodes per day was reduced from 5.0 times before to 1.9 times after treatment. In the urodynamic study, mean maximum cystometric capacity and Valsalva leak point pressure increased from 197 +/- 53.2 to 309 +/- 85.3 ml and from 67.3 +/- 22.6 to 97.1 +/- 22.7 cm H2O after treatment, respectively (p < 0.05). 3 of 6 patients who showed improvement returned to the baseline values within 12 months after treatment and requested maintenance ExMS therapy. No side effects were observed.

CONCLUSIONS: ExMS therapy offered a new option for urinary incontinence treatment after radical prostatectomy. Further studies are required to determine how long the benefits of treatment last and whether maintenance therapy is necessary.

Neurol Clin Neurophysiol. 2004 Nov 30;2004:44.

Study on optimization for current distribution in magnetic stimulation therapy for urinary incontinence.

Odagaki M, Suga K, Sasaki T, Hosaka H.

Graduate School of Science and Engineering, Tokyo Denki University, Japan. odagaki@b.dendai.ac.jp

Abstract

It has been reported that magnetic stimulation effectively eliminates urinary incontinence. However, this type of therapy has not been established as a practical treatment for urinary incontinence because of its poor power conversion efficiency and the leakage of current to regions other than that of the target of stimulation. It is therefore necessary to develop magnetic stimulators that are more efficient in stimulating the sphincter muscles and the peripheral nerves, and are more convenient than those presently available. By using a large-diameter coil, the magnetic stimulation method offers a larger current distribution over a wider area of the target region than electrical stimulation method, and the placement of the coil can be relatively easily changed to obtain better therapeutic results. We attempted, with a computer simulation model of the female abdomen, to simulate the distribution of the induced current density on the basis of biological tissue conductivity. We determined which method of stimulation is the most efficient by varying the stimulator coil location and size. A genetic algorithm (GA) was used for optimization.

Int J Urol. 2004 Aug;11(8):602-6.

Extracorporeal magnetic innervation treatment for urinary incontinence.

Yokoyama T, Fujita O, Nishiguchi J, Nozaki K, Nose H, Inoue M, Ozawa H, Kumon H.

Department of Urology, Okayama University Graduate School of Medicine and Dentistry, Okayama 700-8558, Japan. uroyoko@md.okayama-u.ac.jp

Abstract

BACKGROUND: Extracorporeal magnetic innervation (ExMI) is a new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We explored whether this new technology is effective for patients with urge incontinence, as well as those with stress urinary incontinence.

METHODS: We studied 20 patients with urge incontinence and 17 patients with stress urinary incontinence. The Neocontrol system (Neotonus Inc., Marietta, GA) was used. Treatment sessions were for 20 min, twice a week for 8 weeks. Evaluations were performed by bladder diaries, one-hour pad weight testing, quality-of-life surveys and urodynamic studies.

RESULTS: Of the urge incontinence cases, five patients were cured (25.0%), 12 patients improved (60.0%) and three patients did not show any improvement (15.0%). Leak episodes per day reduced from 5.6 times to 1.9 times at 8 weeks (P < 0.05). Eight patients with urge incontinence recurred within 24 weeks after the last treatment (47.1%). Of the stress incontinence cases, nine patients were cured (52.9%), seven patients improved (41.1%) and one patient did not show any improvement (6%). In one-hour pad weight testing, the mean pad weight reduced from 7.9 g to 1.9 g at 8 weeks (P < 0.05). Three patients returned to the baseline values within 24 weeks after the last treatment (17.6%). No side-effects were experienced by any of the patients.

CONCLUSION: Although the results for urge incontinence were less effective than for stress urinary incontinence, ExMI therapy offers a new option for urge incontinence as well as stress urinary incontinence.

J Urol. 2004 Apr;171(4):1571-4; discussion 1574-5.

Urodynamic and clinical evaluation of 91 female patients with urinary incontinence treated with perineal magnetic stimulation: 1-year followup.

Almeida FG, Bruschini H, Srougi M.

Urology Departments Federal University of São Paulo-UNIFESP/EPM, São Paulo, Brazil.

Abstract

PURPOSE: We evaluate the perineal magnetic stimulation (PMS) effect on continence and quality of life in women with urinary incontinence.

MATERIALS AND METHODS: We prospective studied 91 women with demonstrable urinary incontinence treated with 16 sessions of PMS. Pretreatment and posttreatment evaluation was done by clinical history, physical examination, voiding diary, validated quality of life survey (I-QOL) and urodynamic study (UDS). Patients with no leakage after treatment were evaluated at 3, 6 and 12 months.

RESULTS: Mean patient age +/- SD was 60.5 +/- 10.1 years. Immediately after treatment the I-QOL score increased 35% (p <0.001), the number of pads daily decreased 40% (p <0.001), the number of leaks daily decreased 54% (p <0.001) and 34 patients (37%) became dry. Of the 91 patients 41 were evaluated before and after treatment by UDS. The average increase in vesical leak point pressure (VLPP) was 24.3% (p = 0.001) and initial VLPP in patients who became dry was greater than 80 cm H2O. After treatment 77% of patients with initial low pressure detrusor overactivity on UDS became free of this condition. One year after discontinuing PMS 94% of patients who became dry immediately after treatment had recurrence.

CONCLUSIONS: Immediately after 16 sessions of PMS women with urinary incontinence have significant improvement in the I-QOL score with decreased daily pad use and leakage episodes but 63% had failure. Therapy is more effective in patients with a VLPP of greater than 80 cm H2O. The beneficial effect is temporary with high and early recurrence after discontinuing treatment.

Urology. 2004 Feb;63(2):264-7.

Comparative study of effects of extracorporeal magnetic innervation versus electrical stimulation for urinary incontinence after radical prostatectomy.

Yokoyama T, Nishiguchi J, Watanabe T, Nose H, Nozaki K, Fujita O, Inoue M, Kumon H.

Department of Urology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.

Abstract

OBJECTIVES: To perform a randomized comparative study to investigate the clinical effects of extracorporeal magnetic innervation (ExMI) and functional electrical stimulation (FES) on urinary incontinence after retropubic radical prostatectomy.

METHODS: Thirty-six patients with urinary incontinence after radical prostatectomy were randomly assigned to three groups (12 patients each in the FES, ExMI, and control groups). For FES, an anal electrode was used. Pulses of 20-Hz square waves at a 300-micros pulse duration were used for 15 minutes twice daily for 1 month. For ExMI, the Neocontrol system was used. The treatment sessions were for 20 minutes, twice a week for 2 months. The frequency of the pulse field was 10 Hz for 10 minutes, followed by a second treatment at 50 Hz for 10 minutes. For the control group, only pelvic floor muscle exercises were performed. Objective measures included bladder diaries, 24-hour pad weight testing, and a quality-of-life survey, at 1, 2, and 4 weeks and 2, 3, 4, 5, and 6 months after removing the catheter.

RESULTS: The leakage weight during the 24 hours after removing the catheter was 684, 698, and 664 g for the FES, ExMI, and control groups, respectively. At 1 month, it was 72, 83, and 175 g (FES versus control, P <0.05) and at 2 months was 54, 18, and 92 g (ExMI versus control, P <0.05) in the FES, ExMI, and control groups, respectively. Finally, 6 months later, the average 24-hour leakage weight was less than 10 g in all groups. Quality-of-life measures decreased after surgery, but gradually improved over time in all groups. No complications were noted in any of the groups.

CONCLUSIONS: ExMI and FES therapies offered earlier continence compared with the control group after radical prostatectomy. We consider ExMI and FES to be recommendable options for patients who want quick improvement of postoperative urinary incontinence.

Scand J Urol Nephrol. 2003;37(5):424-8.

Extracorporeal magnetic stimulation for the treatment of stress and urge incontinence in women–results of 1-year follow-up.

Unsal A, Saglam R, Cimentepe E.

Department of Urology, School of Medicine, Fatih University, Ciftlik Cd. No: 57, TR-06510 Emek, Ankara, Turkey. unsalali@hotmail.com

Abstract

OBJECTIVE: To evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress and urge urinary incontinence in women.

MATERIAL AND METHODS: A total of 35 patients with stress incontinence and 17 with urge incontinence were enrolled in this study. All patients were evaluated by means of a detailed history of incontinence, a gynecologic examination, urine culture, urinary system ultrasound and a urodynamic study. All patients were asked to keep a 3-day voiding diary. A pad-weighing test was done for each patient at their first visit. For treatment, the patients were seated on a special chair containing a magnetic field generator. Pelvic floor muscle stimulation was performed for 20 min (10 min at 5 Hz and 10 min at 50 Hz) twice a week for a total of 8 weeks. The mean follow-up period was 16.8 months (range 12-32 months). A total of 44 patients completed 1 year of follow-up and were re-evaluated by means of voiding diary, pad-weighing test and cystometric study.

RESULTS: Of the 44 patients, 11 (38%) with stress incontinence and 6 (40%) with urge incontinence were cured 1 year after the treatment. In addition, there was an improvement in symptoms in 12 patients (41%) in the stress group and 7 (47%) in the urge group. Pad weight was reduced from 15.4 to 5.8 g in the stress group and from 12.4 to 4.7 g in the urge group (p = 0.000 and 0.001, respectively). Mean Valsalva leak point pressure was increased from 87.3 +/- 15.9 to 118.0 +/- 11.0 cmH (2) O in the stress group (p = 0.000).

CONCLUSIONS: Extracorporeal magnetic stimulation therapy offers a non-invasive, effective and painless treatment for stress and urge incontinence in women.

Altern Ther Health Med. 2003 Jul-Aug;9(4):38-48.

Effects of a pulsed electromagnetic therapy on multiple sclerosis fatigue and quality of life: a double-blind, placebo controlled trial.

Lappin MS, Lawrie FW, Richards TL, Kramer ED.

Energy Medicine Developments, (North America), Inc., Burke, Va., USA.

Abstract

CONTEXT: There is a growing literature on the biological and clinical effects of pulsed electromagnetic fields. Some studies suggest that electromagnetic therapies may be useful in the treatment of chronic illnesses. This study is a follow-up to a placebo controlled pilot study in which multiple sclerosis (MS) patients exposed to weak, extremely low frequency pulsed electromagnetic fields showed significant improvements on a composite symptom measure.

OBJECTIVE: To evaluate the effects of a pulsed electromagnetic therapy on MS related fatigue, spasticity, bladder control, and overall quality of life.

DESIGN: A multi-site, double-blind, placebo controlled, crossover trial. Each subject received 4 weeks of the active and placebo treatments separated by a 2-week washout period.

SETTING: The University of Washington Medical Center in Seattle Wash, the Neurology Center of Fairfax in Fairfax, Va, and the headquarters of the Multiple Sclerosis Association of America in Cherry Hill, NJ.

SUBJECTS: 117 patients with clinically definite MS.

INTERVENTION: Daily exposure to a small, portable pulsing electromagnetic field generator.

MAIN OUTCOME: The MS Quality of Life Inventory (MSQLI) was used to assess changes in fatigue, bladder control, spasticity, and a quality of life composite.

RESULTS: Paired t-tests were used to assess treatment differences in the 117 subjects (81% of the initial sample) who completed both treatment sessions. Improvements in fatigue and overall quality of life were significantly greater on the active device. There were no treatment effects for bladder control and a disability composite, and mixed results for spasticity.

CONCLUSIONS: Evidence from this randomized, double-bind, placebo controlled trial is consistent with results from smaller studies suggesting that exposure to pulsing, weak electromagnetic fields can alleviate symptoms of MS. The clinical effects were small, however, and need to be replicated. Additional research is also needed to examine the possibility that ambulatory patients and patients taking interferons for their MS may be most responsive to this kind of treatment.

Urologe A. 2003 Jun;42(6):819-22. Epub 2003 Jan 17.

Magnet stimulation therapy: a simple solution for the treatment of stress and urge incontinence?

[Article in German]

Kirschner-Hermanns R, Jakse G.

Urologische Klinik, Universitätsklinikum, RWTH Aachen.

Abstract

AIM: Magnet stimulation therapy has been offered as a new, conservative therapy for stress and urge incontinence in Germany since 2001. Focussed, pulsating magnetic fields are used to stimulate the musculature of the floor of the pelvis. This publication describes our initial experience with this method.

PATIENTS AND METHODS: We treated 27 patients with magnetic stimulation. The individual patient sits clothed on a therapy-chair and is treated for 20 min twice a week for 2 weeks.

RESULTS: The best results were recorded in female patients with grades I and II stress incontinence who could not actively flex their pelvic-floor musculature during physiotherapy. A marked reduction in the frequency of micturition was obtained in 67% of patients with urge incontinence symptoms and non-responsiveness to anticholinergic therapy. Patients with a non-organically tangible pelvic-pain-syndrome did not benefit from the therapy.

CONCLUSIONS: Magnet stimulation therapy can act as a useful addition to conservative therapies for stress and urge incontinence. It is free of complications and does not involve the insertion of an electrode into the patient as is the case for vaginal and anal electrostimulation. However, this method does not appear to be useful for chronic, non-specific pain in the lower pelvis.

Urology. 2000 Dec 4;56(6 Suppl 1):82-6.

Update on extracorporeal magnetic innervation (EXMI) therapy for stress incontinence.

Galloway NT, El-Galley RE, Sand PK, Appell RA, Russell HW, Carlin SJ.

Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.

Pulsed magnetic technology has been developed for pelvic floor muscle strengthening for the treatment of urinary incontinence. This report includes an update of the prospective multicenter study of extracorporeal magnetic innervation (ExMI) therapy for stress incontinence and a discussion of the possible mechanisms of action. Issues of patient selection for ExMI therapy will also be discussed. One hundred and eleven women with demonstrable stress urinary incontinence were studied. The mean age was 55 +/- 13 years, and the mean duration of symptoms was 11 years. Ninety-seven completed ExMI therapy and analysis. Evaluation before treatment included bladder diaries, dynamic pad weight test, urodynamics, and a quality-of-life survey. For treatment the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy head in the seat. Treatment sessions were for 20 minutes, twice a week, for 6 weeks. After ExMI therapy, all of the measures were repeated at 8 weeks, including the dynamic pad weight testing and quality-of-life survey. At 6 months, further data were added, including repeat bladder diary, pad use, and quality-of-life survey. Forty-seven women completed 6 months of follow-up; of the 47, 13 patients were completely dry (28%) and 25 used no pad or less than 1 pad per day (53%). Pad use was reduced in 33 patients (70%). The median number of pads was reduced from 2.16 to 1 per day (Wilcoxon signed rank test, P <0.005). The frequency of leak episodes was reduced from 3.0 to 1.7 at 6 months (Wilcoxon signed rank test, P = 0.004). Detrusor instability was demonstrated in 10 before and 6 after ExMI (P <0.05). ExMI offers an alternative approach for the treatment of urinary incontinence. ExMI therapy is effective for both stress and urge incontinence. The best results are achieved in those patients who use no more than 3 pads a day and have had no prior continence surgery.

Obstet Gynecol Surv. 2000 Nov;55(11):715-20.

Electromagnetic pelvic floor stimulation: applications for the gynecologist.

Goldberg RP, Sand PK.

Evanston Continence Center, Northwestern University Medical School, Evanston Northwestern Healthcare, Illinois, USA. r-goldberg@nwu.edu

Abstract

The therapeutic potential of magnetic energy has been a subject of long-standing interest within both conventional and alternative medical practice. Numerous devices using magnetic fields, ranging from the dubious to truly innovative, have claimed a wide variety of clinical benefits. For gynecologists involved with the diagnosis and treatment of pelvic floor and bladder dysfunction, magnetic stimulation of the sacral nerve roots and peripheral nerves continues to evolve as a noninvasive treatment alternative. The conduction characteristics of magnetic energy confer several practical advantages for its use. This article reviews the use of electromagnetic stimulation for treatment of common urogynecologic conditions, and provides an historical overview of the therapeutic application of electromagnetic energy.

Urology. 1999 Jun;53(6):1108-11.

Extracorporeal magnetic innervation therapy for stress urinary incontinence.

Galloway NT, El-Galley RE, Sand PK, Appell RA, Russell HW, Carlan SJ.

Emory University School of Medicine, Atlanta, Georgia, USA.

Abstract

OBJECTIVES: To report the first data from a prospective clinical study to determine the feasibility of using extracorporeal magnetic innervation (ExMI) for the treatment of stress urinary incontinence.

METHODS: We studied 83 women with demonstrable stress urinary incontinence. Treatments were for 20 minutes, twice a week for 6 weeks. For treatment, the patient sits fully clothed on a special chair; within the seat is a magnetic field generator that produces the rapidly changing magnetic field flux. Objective measures included bladder diaries, dynamic pad weight testing, urodynamic studies, and quality of life survey.

RESULTS: Fifty patients have been followed up for longer than 3 months (33 patients for less than 3 months); 17 patients (34%) were dry, 16 (32%) were using not more than 1 pad per day, and 17 (34%) were using more than 1 pad per day. Pad use was reduced from 2.5 to 1.3 (P = 0.001) and leak episodes per day were reduced from 3.3 to 1.7 (P = 0.001). The pad weight was reduced from 20 to 15 g. Detrusor instability was found in 5 patients before but was demonstrated in only 1 patient after treatment.

CONCLUSIONS: ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI is painless, there is no need for a probe, and no need to undress for treatments. Longer follow-up is required to determine how long the benefits of treatment last and whether retreatment will be necessary.

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