Efficacy of transcutaneous perineal electrostimulation versus intracavitary anal electrostimulation in the treatment of urinary incontinence after a radical prostatectomy: Randomized controlled trial

Abstract

Aim: To compare the efficacy of the treatment with transcutaneous perineal electrostimulation versus intracavitary electrostimulation to reduce the frequency of urinary incontinence after radical prostatectomy and the impact on the quality of life (QoL).

Methods: This single-blind equivalence-randomized controlled trial equally (1:1) randomly allocated men with urinary incontinence post radical prostatectomy into surface electrodes perineal group (intervention group, IG) and intra-anal probe group (control group, CG). Outcomes included changes in the 24h-Pad Test (main variable), and ICIQ-SF (International Consultation on Incontinence Questionnaire Short-Form), SF-12 (Short Form Health Survey), and I-QOL (incontinence quality of life questionnaire) questionnaires. Clinical data were collected at baseline, 6 and 10 weeks. For the comparisons between variables, χ² test and Student's t test were used. Equivalence was analyzed by estimating the mean change (90% confidence interval) of urinary incontinence based on the Pad Test. The analysis was performed for the per-protocol and the intention-to-treat populations. Statistical significance level was set at p < 0.05.

Results: Seventy patients were included, mean age 62.8 (SD 9.4) years. Mean baseline 24h-Pad Test was 328.3 g (SD 426.1) and a significant decrease (p < 0.001) in the grams of urine loss at 5 weeks (159.1 g in the IG and 121.7 g in the CG), and at 10 weeks of treatment (248.5 g in the IG and 235.8 g in the CG) was observed. However, the final difference in the grams of urine loss between both treatments showed the absence of statistical significance (p = 0.874). In both groups, the ICIQ-SF, I-QOL, and SF-12 questionnaires revealed a significant improvement in QoL.

Conclusion: Surface and intra-anal electrostimulation treatments reduced significantly losses of urine, but differences in grams of urine loss throughout the therapy between groups were not significant, suggesting that the efficacy of the two treatments is not statistically different. Nonetheless, the improvement observed in both groups was statistically significant and clinically relevant.

Keywords: intra-anal probe electrostimulation; male urinary incontinence; postprostatectomy incontinence; randomized controlled trial; surface electrodes electrostimulation.