In perimenopausal women with overactive bladder (OAB), pelvic floor electrical stimulation (PFS) in combination with local vaginal estrogen effectively reduces symptoms, a new study finds.
A research team led by Ahmed Abdelbary, MD, of Bani Swaif University in Cairo, Egypt recruited 315 perimenopausal women suffering with symptoms such as frequency, nocturia, urgency, and urge incontinence. Investigators randomly assigned women to 1 of 3 treatments for 6 weeks: PFS alone, local estrogen alone (2 grams daily of 0.625 mg/g estrogen cream), or a combination of PFS and estrogen. Clinicians administered PFS treatment (pulses of 20 Hertz for 320 milliseconds to the vaginal area) twice a week for 30 minutes. Using patient reports along with laboratory and clinical results, the investigators recorded the effects of treatment on day and nighttime frequency, incontinence episodes, urgency, detrusor overactivity, and functional bladder capacity.
Starting 1 week into treatment, all 3 groups showed significant improvement in their OAB symptoms, according to results published in Urology. Except for detrusor overactivity, PFS monotherapy produced better symptom relief overall than estrogen alone. Patients receiving a combination of PFS and local estrogen fared the best, however, experiencing reductions in both urgency and incontinence.
Estrogen appears to enhance the effect of PFS and can delay the recurrence of urge incontinence. “The sustained effect may be due to the improvement in tissue quality which may lead to better conductivity that can augment the results of PFS and make improvement more stable,” the investigators explained.
Symptom relief may be temporary, however. After 6 weeks of active therapy, benefits deteriorated over the following 6 months in all treatment groups, with the exception of incontinence episodes in the combination therapy group.
“Further long-term studies are needed to evaluate the best dosing of estrogen, the proper schedule of PFS, the ideal period of treatment, and the possible retreatment methods,” the researchers noted. The studies should include the addition of third-line treatment with anticholinergics.
Among the study's limitations, the placebo effect cannot be ruled out, since depression plays a role in OAB.
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