Differentiated approach to the choice of therapy for stress urinary incontinence in women with pelvic floor dysfunction

BACKGROUND: Among the symptoms of pelvic floor dysfunction, urinary incontinence is common in young patients. Stress urinary incontinence disrupts psychological health, sexual and social life. The effectiveness of modern conservative treatments for mild stress urinary incontinence in women of reproductive and perimenopausal age is being studied to prevent disease progression and improve the quality of life.

AIM: The aim of this study was a comparative assessment of the effectiveness of pelvic floor muscle training using the Tyulpan laser vaginal simulator and paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age with pelvic floor dysfunction.

MATERIALS AND METHODS: We examined 82 patients aged 43.35 ± 6.25 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies, including voiding diaries, Urgency Bother Visual Analogue Scale, cough test, ultrasound of the urethrovesical junction and pelvic floor, 41 women were prescribed a course of remote pelvic floor muscle training under medical supervision using the Tyulpan laser vaginal simulator (group I). 41 patients underwent paraurethral injection of 4.0 ml of high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether (group II). The effectiveness of therapy was evaluated one, six and 12 months after the start of treatment.

RESULTS: After one month, the absence of stress urinary incontinence episodes based on voiding diaries was found in 29.4% of patients in group I and in 85.4% of patients in group II (2.9 times more often) (p < 0.001); after 12 months, in 73.1% of patients in group I and in 36.4% of patients in group II (half as often) (p = 0.011). After one month, a negative cough test was detected in 65.0% of women in group I and in 92.1% of women in group II (1.4 times more often) (p = 0.023). After six months, the results of treatment for stress urinary incontinence based on the cough test were not different and amounted to 80.0% in group I and 71.9% in group II (p = 0.725). When assessing the pelvic floor muscle strength using the Oxford Scale and perineometry, an increase in strength after one and six months was detected in 100% of patients in group I (p < 0.001). Both techniques equally reduced urethral mobility as measured by ultrasound over the one-month follow-up. Pelvic floor muscle training more significantly improved the quality of life of women 12 months after the start of therapy (p < 0.05).

CONCLUSIONS: The introduction of high-density hyaluronic biopolymer leads to a rapid and pronounced positive result in the treatment of stress urinary incontinence and an improvement in the quality of life in the short term; it is recommended for patients interested in quickly achieving results, informed about the limited duration of the effect. Regular training of the pelvic floor muscles in biofeedback mode under the remote control of a doctor contributes to better results in the long term. This method is recommended for women who are able to contract the pelvic floor muscles and are ready for regular exercise.