Does percutaneous tibial nerve stimulation improve global pelvic function in women with faecal incontinence?

Effect of knack technique on vaginal laxity in multiparous women: A randomized controlled trial

BACKGROUND

Vaginal laxity defined according to the International Urogynecological Association/International Continence society is excessive vaginal looseness; it is one of the most common symptoms of pelvic floor dysfunction, which refers to medical/functional disorders that can have a significant impact on a woman's sexual self-esteem and sexual life.

AIM

This study aimed to determine the impact of the Knack Technique on Pelvic floor muscle (PFM) and sexual function in women with vaginal laxity.

METHODS

Thirty females complaining of vaginal laxity were randomly chosen from the outpatient clinic at Deraya University. Their ages varied from 35 to 45 years, their body mass index was 25-30 kg/m2, and a number of parities ≤ three normal vaginal deliveries and at least two years from the last delivery complaining about vaginal laxity, water entrapment, and loss of friction during sexual intercourse. They were randomized into two equal groups at random (A, B). Group A (15 females) received (PSTES) and group B (15 females) received (PSTES) and Knack Technique. Both the groups received three sessions per week for 2 months.

EVALUATION

The outcome measures were evaluated through pre- and post-interventions by using ultrasonography imaging to assess PFM function, Sexual Satisfaction Index, and Vaginal Laxity Questionnaires (VLQ) to assess sexual function.

RESULTS

Analysis indicated a significant improvement in vaginal laxity in the two groups. Comparison between groups pre- and posttreatment showed that there was no statistically significant difference between the groups B and A in SSI and VLQ, while there were significant differences between the groups A and B in PFM force.

CONCLUSION

Combining Parasacral transcutaneous electrical stimulation (PSTES) and Knack Technique is more effective than PSTES alone in reducing vaginal laxity as well as improving PFM and sexual function in women with vaginal laxity.

Efficacy of Neuromodulation Interventions for the Treatment of Sexual Dysfunction: A Systematic Review

OBJECTIVES

The primary aim of this review was to analyze the literature for the efficacy of neuromodulation interventions in treating both male and female sexual dysfunction.

MATERIALS AND METHODS

Studies were identified from PubMed, Scopus, PsychINFO, CINAHL, and Cochrane. Results were synthesized qualitatively without pooling owing to the heterogeneous nature of outcome assessments.

RESULTS

Overall findings from studies generally supported that neuromodulation interventions were associated with improvement in sexual function. Specific domains that improved in male patients included erectile function, desire, and satisfaction, whereas desire, arousal, orgasm, lubrication, quality of "sex life," intercourse capability, and dyspareunia improved in female patients. Male ejaculation, orgasm, and intercourse capability were the only domains that continued to decline after the use of neuromodulation interventions, although this was only reported in one study.

CONCLUSION

Our review suggests that there may be promise and potential utility of neuromodulation in improving sexual dysfunction; however, further research is needed.

The Role of Percutaneous Tibial Nerve Stimulation (PTNS) in Low Anterior Resection Syndrome (LARS): A Systematic Review and Meta-analysis

PURPOSE

The aim of the present study was to evaluate the pooled efficacy of percutaneous tibial nerve stimulation (PTNS) in patients with low anterior resection syndrome (LARS).

MATERIAL AND METHODS

This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The primary endpoint was the pooled effect size of PTNS in LARS score (LARSS). Secondary endpoints included incontinence (Fecal Incontinence Score-FIC, Obstructive Defecation Syndrome-ODS), sexual functionality and quality of life (QoL) questionnaires, and manometric evaluations. Continuous outcomes were reported as weighted mean difference (WMD), with the corresponding 95% confidence interval (95% CI). Quality evaluation was performed via the National Institutes of Health (NIH) quality assessment tool.

RESULTS

Overall, 5 studies were included. PTNS resulted to reduced LARSS values (WMD: - 5.68, 95%CI: - 7.73, - 3.63, p < 0.001). A similar effect was noted in St Mark's FIC (p < 0.001) and ODS (p = 0.02) score. An improvement in several QoL scales was found. There was no effect in sexual functionality and manometric measurements. Compared to sham, PTNS significantly improved LARSS.

CONCLUSIONS

The application of PTNS in patients with LARS results in an improvement in multiple clinical parameters, including defecation functionality and quality of life. Due to several study limitations, further high quality RCTs are required to delineate the exact efficacy of PTNS.

Posterior Tibial Nerve Stimulation in Fecal Incontinence: A Systematic Review and Meta-Analysis

Introduction:

The present systematic review and meta-analysis aims to investigate the role of Posterior Tibial Nerve Stimulation (PTNS) in the control of Fecal Incontinence (FI).

Methods:

Two independent reviewers extensively searched in the electronic databases of Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, CINAHL, and Scopus for the studies published until the end of 2016. Only randomized clinical trials were included. The studied outcomes included FI episodes, FI score, resting pressure, squeezing pressure, and maximum tolerable pressure. The data were reported as Standardized Mean Differences (SMD) with 95% confidence interval.

Results:

Five articles were included in the present study (249 patients under treatment with PTNS and 239 in the sham group). Analyses showed that PTNS led to a significant decrease in the number of FI episodes (SMD=−0.38; 95% CI: −0.67–0.10; P=0.009). Yet, it did not have an effect on FI score (SMD=0.13; 95% CI: −0.49–0.75; P=0.68), resting pressure (SMD=0.12; 95% CI: −0.14–0.37; P=0.67), squeezing pressure (SMD=−0.27; 95% CI: −1.03–0.50; P=0.50), and maximum tolerable pressure (SMD=−0.10; 95% CI: −0.40–0.24; P=0.52).

Conclusion:

Based on the results, it seems that the prescription of PTNS alone cannot significantly improve FI.

Neuromodulation for the Treatment of Endometriosis-Related Symptoms

Sacral and pudendal neuromodulation have been advocated for the treatment of refractory pelvic pain, urinary urgency and retention, as well as fecal incontinence or constipation, all of which are commonly related to endometriosis and/or its surgical treatment.

In this review, the mechanisms of action and different routes of neuromodulation will be detailed, as well as all the studied applications of neuromodulation on ameliorating symptoms related to endometriosis and/or its treatment.