Effect of transvaginal stimulation in the treatment of detrusor instability

Early research on implantable electrodes for transvaginal stimulation had high rates of complications and mechanical failures. Today's nonimplantable devices are safe for short-term or long-term use. This study evaluated an intermittent short-term transvaginal stimulation program for treatment of bladder overactivity.

Fifteen women who ranged in age from 22 to 96 years and had bladder instability were enrolled into this noncontrolled, open, clinical evaluation program. Six to 10 biweekly office sessions were followed by use of a home unit twice daily for approximately 6 weeks.

Results were based on patients' voiding diaries. All 15 completed the study, and 73% were satisfied with the results. On pretrial urodynamic examination nine patients had sensory urgency, and six patients had involuntary contractions. All tolerated therapy without side effects. Two women had slight vaginal discomfort because of vaginal narrowing. Urinary frequency, urgency, and nocturia were significantly decreased. Seven women reported 75% or more improvement; four women reported 50% to 75% improvement. Three women required a second office treatment series.

The results of this study support findings of previous researchers, although the follow-up time frame of the study was short. Most of these patients (N = 11 of 15) wished to continue transvaginal stimulation. When three women discontinued home treatments, symptoms recurred in 1 to 3 months. The exact cause is unclear, but scar tissue as a result of previous pelvic operations may have contributed to the problem. The second course of treatment had positive results. Intermittent therapy in these cases is recommended. Transvaginal stimulation should be considered for treatment for urinary incontinence because the device is easily used and adjusted by the patient, patients may be very compliant, and results are satisfactory and at least similar to those attained with drug therapy.