Mean patient age was 52.2±10 years, with a median ΒΜΙ 27.6kg/m2. Approximately half the participants suffered from SUI (n=90, 47.9%), and the rest from MUI (n=98, 52.1%). Median number of deliveries was 2 (IQR=1), with 32.9% of women reporting delivery of overweight neonates. The majority (122/188, 64.9%) of patients were postmenopausal, and 37(19.7%) had a history of gynecological surgery. One out of 5 women (22.3%, n=42) required simultaneous prescription of medication for incontinence; 13.8% (n=26) were using anticholinergics, 4.3% (n=8) duloxetine, 2.1% (n=4) mirabegron, and 4 patients (2.1%) received combination treatment (anticholinergic plus α-blocker in 2 and duloxetine plus anticholinergic in 2).
Bladder diaries recorded a median 9 urinations daily (IQR=2), 3 episodes of incontinence (IQR=3) and usage of 3 pads daily (IQR=3) at baseline. Median volume of fluid consumed daily was 1615ml (IQR=600) and voided volume varied between 480 (max) and 100 ml(min) (IQR=260-60).
In women undergoing urodynamic investigation, mean cystometric capacity was 402ml (IQR=265), Qmax 21ml/s (IQR=13) and PVR 0ml (ΙQΡ=40). Detrusor overactivity was diagnosed in 17 patients (33,3%) while urodynamic SUI was diagnosed in the majority of patents (60,8%) and UUI in only 15,7%.
Effect of PFMT on incontinence. The median number of pads used daily at baseline was 3 (IQR=2), with 38.8% of women reporting only loss of drops, 50.5% moderate incontinence and 10.6% severe urine leakage. The number of pads was reduced to 1(IQR=1) after PFMT (p<0,001) for the total sample.
At baseline, stress test was negative in 43.1% of women. In the remaining patients, the test was mildly positive (small leak) in 26.1%, moderately positive in 20.2% and severely positive in 10.6% of patients. At 3 months, stress test was negative in 88.8%, while 10.1% of patients had a small leak and 1.1% more severe incontinence. Concerning urgency symptoms, 51% of patients with MUI had daily urgency incontinence, 26.5% reported weekly symptoms and the rest (22.4%) monthly. Severity of urgency incontinence varied from drops in 52% of patients with MUI, to moderate leak in 39.8% and severe urine loss in 8.2%.
At 3 months, 10% of the SUI and 11.2% of the MUI subgroups were cured from SUI (overall 20 [10.6%] patients), while 35 (35.7%) of those with MUI reported being free of urgency incontinence. Bivariate analysis of patients completely cured from SUI for predictive factors revealed a strong correlation only with negative or mildly positive stress test (p=0,014, x2 test Linear-by-Linear). However, this significance was lost on binary logistic regression including all the aforementioned factors.
Similarly, complete treatment of urgency incontinence in women with MUI was investigated. Again, only lower severity of stress test (p=0.009, x2-test) related to complete relief of symptoms. Furthermore, binary logistic regression including the previous factors confirmed the relation of initially negative stress test (p=0,003) or mildly positive stress test (p=0,007) with complete cure of SUI in the MUI subgroup.
Moreover, 50% improvement in number of pads was calculated for all patients and explored in terms of recognizing predictive variables. Assessment after PFMT revealed >50% reduction in number of pads in 107 (56.9%) patients (60% in those exclusively with SUI and 54.1% in MUI). Bivariate analysis showed that patients with a history of gynecological surgery had 51.3% less probability for improvement compared to other groups without being statistically significant (p=0.128). Multivariate analysis (binary logistic regression) showed medication consumption as possible independent variable but the relation was not statistically significant. Subgroup analysis between patients with SUI and MUI showed that only improvement in endurance in patients with MUI related independently with >50% reduction in pad numbers (OR=3.794, p=0.019), signifying that increase in endurance for 1 sec results in 133% increase in possible reduction of pad numbers (by 50%).
Other secondary outcomes. At baseline, 61.2% of women suffered from frequency compared to 31.4% in the last follow-up (p<0,001, McNemar test). Nocturia also improved significantly (67% vs. 43.6% of patients, p<0,001, McNemar test). Constipation also improved significantly, reported from 67 patients at baseline vs. 48 at 3 months (p<0,001 McNemar).
Digital evaluation of pelvic floor showed significant improvement in endurance (p<0.001, md1=4, IQR1=2, md2=6, IQR2=2), number of repetitions (p<0.001, md1=5, IQR1=1 - md2=6, IQR2=2) and fast contractions (p<0.001, md1=6, IQR1=2 - md2=8, IQR2=3) but not in muscle strength (p=0.157, Wilcoxon signed ranks test).