Hypothesis / aims of study
Stress urinary incontinence (SUI) is defined as any involuntary loss of urine in exertion, sneezing or coughing, which affects about 14% to 50% of the female population. Radiofrequency (RF) is a new therapeutic possibility that may aid in one of the pathophysiological mechanisms of SUI which is the decrease of collagen in the urethral walls. Thus, the objective of this study was to verify clinical response, quality of life, sexual function and satisfaction with non-ablative radiofrequency treatment for stress urinary incontinence in women.
Study design, materials and methods
This is a randomized clinical trial. We included women with SUI (Pad Test> 1g), muscle function ³3 on the OXFORD scale, age range between 30 to 59 years and patients at the Center of Attention to the Pelvic Floor. After the consent, an initial evaluation was made composed by anamnesis, voiding diary, muscle function evaluation (PERFECT), 1 hour Pad Test, and the application of the Female Sexual Function Index (FSFI), the SF-36 questionnaire and the King's Health Questionnaire (KING). The women were randomized into two groups, the radiofrequency group (GR) in which 5 sessions of non-ablative monopolar RF were performed in the external urethral meatus (Figure 1), with a temperature of 39-41ºC for 2 minutes, and the control group (CG) that followed the same protocol, however the RF was switched off and coated with heated glycerin. Both performed home exercises. After a week of the last session of RF were reassessed the Pad Test, questionnaires, muscle function, voiding diary and questioned the participants satisfaction with the treatment.
The sample consisted of 13 women in the GR and 9 in the CG, in which they presented homogeneity in sociodemographic and clinical characteristics. There was a reduction in the variability of urinary loss in GR (p = 0.04) with a magnitude of the effect by Cohen's D of 0.960. In the GR, a reduction in urinary loss was observed through voiding diary (p = 0.025), increase of strength, endurance, resistance and fastness of the PERFECT scheme (p <0.05 for all) and positive impact of King questionnaire in the physical, social limitation domains, and severity of symptoms (p <0.05). There was no change in sexual function and quality of life by SF-36. The 11 (88%) GR women reported that they very satisfied.
Interpretation of results
The present study demonstrates a decrease in urinary loss with the use of non-ablative monopolar radiofrequency (RF) in the urethral external meatus, and consequent satisfaction with the treatment of SUI in the short term, without adverse effects.
The criteria used to evaluate the RF clinical response in the short term were Pad Test of one hour, frequency of urinary loss mentioned by the three-day urinary diary and muscle function. All outcomes showed a clinical improvement in RG, indicating a new therapeutic possibility and without adverse effects.