Konservative Therapie der Stressharninkontinenz: Sieben Jahre Pelvic-Floor-Reeducation-Programm an der Universitätsfrauenklinik München-Großhadern Eine retrospektive Studie mit Follow-up-Fragebogen bei 390 Patientinnen

The aim of this study is, besides the elaborate documentation of
the Pelvic-Floor- Reeducation-Concept, to illustrate and discuss
the short and long term efficacy of the conservative incontinence
therapy that has been applied at the University Clinic Grosshadern
for the last seven years. In addition, predictable factors will be
discussed, which serve as a foundation to better judge the
therapeutic outcome. In the objectives of research section, the
short and long term effectiveness of an intensive
EMG-Biofeedback-assisted pelvic floor muscle training for the
treatment of female stress or mixed urinary incontinence is
examined. The other purpose is the comparison of two different
groups of patients (successfully completed treatment versus not
completed therapy). Another question that was examined is, can
factors for a successful therapy be predicted? Materials and
Methods: The patients examined for this study, were all of the
women that were treated for stress-urinary incontinence or mixed
urinary incontinence between September 1996 and March 2003 in our
clinic in the urogynecology department within the
Pelvic-Floor-Reeducation-Program (PFR). For methodical reasons, the
patients were divided in to three separate groups. Group 1
consisted of the patients that completed the program successfully.
Group 2 consisted of the patients that had started the program, but
had not completed it. Group 3 consisted of patients that did not
participate in the program, but instead just had a counseling
interview. The diagnostics involved: an urodynamic measurement, the
stress provocation test (cough test), the determination of maximum
pelvic floor muscle strength, with the help of palpatoric
diagnostic (Oxford-Score, Scale 0–5), and an EMG (Maximum
contraction; PERFECT-Measurement). According to the PFR concept,
the patients received an extensive incontinence counseling session,
instructions for individual pelvic floor exercises, and
copingstrategies for dealing with incontinence in every day
situations. The biofeedback therapy was done with the use of
PC-controlled electromyography (ST2001, Haynl Elektronik). The
follow-up consisted of 92 a standardized questionnaire. In the
analysis of potential predictable factors, the following parameters
were used: Age > 65, BMI ≥ 30, Parity, duration of incontinence
> 5 years, SIK III,, Hypotony Urethra (≤ 25 cm H²O), weak pelvis
floor contraction (Oxford < 2) and motivation for the training.
Results: During the period of seven years, a total of 434 women
were treated with the Pelvic-Floor-Reeducation-Program. For this
study, a total of 390 of the 434 women, who suffered from either
stress-urinary incontinence (79.7 %) or mixed urinary incontinence
(20.3 %), were evaluated. Average age: 52, mean incontinence
duration: 6.7 years. 60.4 % of the women suffered from a SIK III.
67.4 % of the women successfully completed the training, while 25.1
% did not. 82.0 % of the patients improved on the stress test. The
average time for follow-up was 2.9 years. The questionnaire return
was 80.0 % (N = 312). 71.0 % of the patients reported that their
problems with incontinence had improved after the training, and
only 13.5 % chose to have surgery for the incontinence. Therefore,
the long term success rate for the treatment is 61.2 % (N = 191).
In comparison to the patients that did not complete treatment,
there are noticeable differences, including the number of
operations, as well as the quality of life. In view of the
therapeutic outcome, the following factors showed a statistically
significant association, which is associated with a more negative
prognosis: Age > 65 (only 50.0 % improvement) and duration of
incontinence > 5 years (54.4 % improvement). Interestingly, the
study showed that women who had given birth, in comparison to woman
with nulliparity and women who initially had weak pelvic floor
contraction strength (Oxford < 2), had better therapeutic
results. Conclusion: An intensive and controlled pelvic floor
training is effective, and should be generally be used before an
operation is considered. Both immediately after the therapy, as
well as in the long-term, the patients profited from the
Pelvic-Floor-Reeducation- Program. The program can often be
avoided, even in severe cases of urinary incontinence. However, the
motivation to successfully complete the PFR training is an
essential factor for the long-term success of the therapy.