Functional Electrical Stimulation

Electrical stimulation has been used for a variety of lower urinary tract symptoms including those of OAB and painful bladder syndrome. There are mainly two types of electrical stimulation: chronic, in which low current is used for many hours daily, and acute submaximal functional electrical stimulation, which is applied up to the patient's tolerance for 15 minutes, once or twice a day, three times a week, or daily. The stimulation can be applied transvagi-nally, transrectally, or transcutaneously. There are a variety of home units that can be used by the patient.

The proposed mechanism of action is alteration of lower urinary tract function by stimulation of the sacral auto-nomic or somatic nerves. There may also be a direct stimulatory effect on pelvic floor muscles and sphincters causing muscular hypertrophy and a change from fast-twitch to slow-twitch fiber types, which can maintain muscle tone more effectively.

The stimulation probe is placed in the vagina at the level of the pelvic musculature in the mid-vagina. During stimulation, the probe is held by the patient to prevent any migration and possible discomfort. Functional electrical stimulation current is pulsed, i.e., short periods of stimulation are alternated with longer rest periods. The strength of the stimulus is adjusted to avoid pain. Low frequency (10-20 Hz) is used for OAB, mid-frequency (50-100Hz) for stress incontinence, and high frequency (200 Hz) for urinary retention. A review of trials of functional electrical stimulation for stress urinary incontinence showed cure in 18% and improvement in 34% of patients. In the treatment of OAB, maximal electrostimulation cured 20% and improved 37% of women with urodynamic detrusor over-activity incontinence.1 Functional electrical stimulation is of limited value in the treatment of stress incontinence.

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