Möglichkeiten und Grenzen der konservativen Therapie der Harninkontinenz

Zusammenfassung

Konservative Therapiemaßnahmen führen bei ca. 60 % der Patientinnen mit Stress- oder gemischter Stress-/Dranginkontinenz zu einer Verbesserung oder Heilung der Symptomatik. Beckenbodentraining ohne oder mit Biofeed-back, Elektrostimulation und Vaginalkonen sind dabei einander nicht überlegen.

Possibilities and limits of the conservative treatment for urinary incontinence

Summary

The conservative treatment of stress or mixed incontinence results in improvement or cure in about 60 % of patients. Pelvic floor muscle training without or with biofeedback, electrical stimulation and vaginal cones are not superior to each other.

Schüsselwörter

Beckenbodentraining - Biofeedback - Elektrostimulation - Harninkontinenz

Key words

Pelvic floor training - Biofeedback - electrical stimulation - urinary incontinence

Literatur

• 1 Andersen J T, Sander P. Minimal care - a new concept for the management of urinary incontinence in an open access, interdisciplinary incontinence clinic. The way ahead? .  Scand J Urol Nephrol Suppl. 1996;  179 55-60
• 2 Berghmans L C, Hendriks H J, Bo K, Hay-Smith E J, de Bie R A, Waalwijk-van-Doorn E S. Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials.  Br J Urol. 1998;  82 81-191
• 3 Bo K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women.  BMJ. 1999;  318 487-493
• 4 Burns P A, Pranikoff K, Nochajski T H, Hadley E C, Levy K J, Ory M G. A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women.  J Gerontol. 1993;  48 M167-M174
• 5 Cammu H, Van Nylen M, Amy J J. A 10-year follow-up after Kegel pelvic floor muscle exercises for genuine stress incontinence.  BJU Int. 2000;  85 655-658
• 6 de Kruif Y P, van Wegen E E. Pelvic floor muscle exercise therapy with myofeedback for women with stress urinary incontinence: A meta-analysis.  Physiotherapy. 1996;  82 107-113
• 7 Glavind K, Laursen B, Jaquet A. Efficacy of biofeedback in the treatment of urinary stress incontinence.  Int Urogynecol J Pelvic Floor Dysfunct. 1998;  9 151-153
• 8 Hay-Smith E J, Bo K, Berghmans L C, Hendriks H J, de Bie R A, van W. Pelvic floor muscle training for urinary incontinence in women (Cochrane Review).  Cochrane Database Syst Rev. 2001;  3
• 9 Henalla S M, Kirwan P, Castleden C M, Hutchins C J, Breeson A J. The effect of pelvic floor exercises in the treatment of genuine urinary stress incontinence in women at two hospitals.  Br J Obstet Gynaecol. 1988;  95 602-606
• 10 Herbison P, Plevnik S, Mantle J. Weighted vaginal cones for urinary incontinence.  Cochrane Database Syst Rev. 2000; 
• 11 Hirsch A, Weirauch G, Steimer B, Bihler K, Peschers U, Bergauer F, Leib B, Dimpfl T. Treatment of female urinary incontinence with EMG-controlled biofeedback home training.  Int Urogynecol J Pelvic Floor Dysfunct. 1999;  10 7-10
• 12 Hofbauer J, Preisinger F, Nurnberger N. The value of physical therapy in genuine female stress incontinence [Ger].  Z Urol Nephrol. 1990;  83 249-254
• 13 Holtedahl K, Verelst M, Schiefloe A, Hunskaar S. Usefulness of urodynamic examination in female urinary incontinence - lessons from a population-based, randomized, controlled study of conservative treatment.  Scand J Urol Nephrol. 2000;  34 169-174
• 14 Jarvis G J. Surgery for genuine stress incontinence.  Br J Obstet Gynaecol. 1994;  101 371-374
• 15 Jonasson A, Larsson B, Pschera H, Nylund L. Short-term maximal electrical stimulation - a conservative treatment of urinary incontinence.  Gynecol Obstet Invest. 1990;  30 120-123
• 16 Kegel A H. Progressive resistance exercise in the functional restoration of the perineal muscles.  Am J Obstet Gynecol. 1948;  56 238-248
• 17 Knight S, Laycock J, Naylor D. Evaluation of neuromuscular electrical stimulation in the treatment of genuine stress incontinence.  Physiotherapy. 1998;  84 61-71
• 18 Kralj B. Conservative treatment of female stress urinary incontinence with functional electrical stimulation.  Eur J Obstet Gynecol Reprod Biol. 1999;  85 53-56
• 19 Lagro-Janssen T, van Weel C. Long-term effect of treatment of female incontinence in general practice.  Br J Gen Pract. 1998;  48 1735-1738
• 20 Miller J M, Ashton-Miller J A, DeLancey J O. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI.  J Am Geriatr Soc. 1998;  46 870-874
• 21 Peschers U M, Gingelmaier A, Jundt K, Leib B, Dimpfl T. Evaluation of pelvic floor muscle strength using four different techniques.  Int Urogynecol J Pelvic Floor Dysfunct. 2001;  12 27-30
• 22 Peschers U M, Vodusek D B, Fanger G, Schaer G N, DeLancey J O, Schuessler B. Pelvic muscle activity in nulliparous volunteers.  Neurourol Urodynam. 2001;  20 269-275
• 23 Ramsay I N, Ali H M, Hunter M, Stark D, McKenzie S, Donaldson K, Major K. A prospective, randomized controlled trial of inpatient versus outpatient continence programs in the treatment of urinary incontinence in the female.  Int Urogynecol J Pelvic Floor Dysfunct. 1996;  7 260-263
• 24 Schiotz H A. One month maximal electrostimulation for genuine stress incontinence in women.  Neurourol Urodynam. 1994;  13 43-50
• 25 Stein M, Discippio W, Davia M, Taub H. Biofeedback for the treatment of stress and urge incontinence.  J Urol. 1995;  153 641-643
• 26 Vierhout M E, Lose G. Preventive vaginal and intra-urethral devices in the treatment of female urinary stress incontinence.  Curr Opin Obstet Gynecol. 1997;  9 325-328
• 27 Weatherall M. Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta-analysis of trials identified in a systematic review.  BJU Int. 1999;  83 1015-1016