Low-frequency electrotherapy for female patients with detrusor underactivity due to neuromuscular deficiency

Abstract

Introduction and hypothesis: The aim of the study was to assess the efficacy of low-frequency electrotherapy (LFE) for female patients with early-stage detrusor underactivity (DUA) due to neuromuscular deficiency.

Methods: A total of 102 female patients were divided randomly into four groups: LFE-NC (normal compliance), LFE-LC (low compliance), CON (control)-NC and CON-LC. Patients in the LFE-NC and LFE-LC groups received LFE, and those in the CON-NC and CON-LC groups received conservative treatment. Urodynamic evaluation was performed before and after treatment.

Results: After treatment, 82 % of the LFE-NC regained detrusor contractility, whereas only 2 (8 %) of the CON-NC had normal detrusor contraction. None of LFE-LC or CON-LC regained detrusor contractility (p < 0.01). The per cent of LFE-NC who relied on catheterization for bladder emptying decreased by 43 % (p < 0.01). Those in the LFE-LC, CON-NC and CON-LC groups decreased by only 4, 12 or 0 % (p > 0.05).

Conclusions: LFE was more effective for DUA patients with normal compliance; these patients benefited from LFE, but DUA patients with low compliance did not.

Fig. 1

Flow diagram of the experimental design and the patient grouping

Fig. 2

Diagrams for LFE method. Diagram of monophasic pulsed rectangular direct current showing phase duration, interpose interval and on/off of the current (a), and diagram of electrode placement from the anterior and posterior views of a female patient (b)

Fig. 3

Comprehensive urodynamic tracings of female patients with detrusor underactivity and normal compliance and the efficacy of LFE are displayed. The dashed arrows indicate normal compliance and solid arrows indicate the state of the detrusor contractility and the sphincter relaxing ability during the voiding phase. a A 32-year-old woman with detrusor underactivity. b After LFE, her detrusor function recovered, sphincter overactivity improved and she dispensed with catheterization thereafter. c Urodynamic study of a 52-year-old female patient showed that the detrusor was underactive and the sphincter overactive before LFE. d After the procedure, the detrusor became contractile and sphincter overactivity still remained

Fig. 4

Comprehensive urodynamic tracings of female patients with detrusor underactivity and low compliance and the failure of LFE are displayed. The dashed arrows indicate lower compliance and solid arrows indicate the state of the detrusor contractility and the sphincter relaxing ability during the voiding phase. a A 38-year-old woman was found to be DUA and LC, urinating by abdominal straining and relying on catheterization for bladder emptying. b After LFE, her detrusor contraction remained poor in spite of slight increase of the detrusor contractility and she still relied on catheterization. c A 54-year-old female patient complained of voiding difficulty with a possible cause of intervertebral disk hernia; urodynamic study showed DUA and LC. d After the LFE procedure, her detrusor and sphincter state remained without improvement at all. As an improvement, her abdominal straining in a parabola fashion was more powerful than before