Interventional procedure overview of transcutaneous electrical neuromuscular stimulation for urinary incontinence

Indications and current treatment

Stress urinary incontinence is the involuntary leakage of urine during exercise or certain movements such as coughing, sneezing and laughing. Urge urinary incontinence is involuntary urine leakage with a feeling of urgency (a sudden compelling desire to urinate that is difficult to delay) during or just before the leakage. Mixed urinary incontinence is involuntary urine leakage associated with both urgency and exercise, effort, sneezing or coughing. These symptoms may be present in women with or without prolapse.

NICE's guideline on urinary incontinence and pelvic organ prolapse has recommendations for the management of urinary incontinence in women, with a patient decision aid to promote shared decision making. NICE's guideline on lower urinary tract symptoms in men has recommendations for the management of urinary incontinence in men. Conventional treatment is conservative and includes lifestyle changes such as weight loss and pelvic floor muscle training. Surgical options are only offered if conservative measures and drug treatments do not help.

What the procedure involves

The procedure uses non-implanted electrodes connected to an external neuromuscular electrical stimulator device to stimulate muscles and nerves, to make the pelvic floor muscles contract. The electrical stimulation is delivered through the skin, typically with sticky pad electrodes. The number and placement of electrodes varies according to the system being used. This includes a design in which the electrodes are incorporated into a body garment worn like a pair of shorts. A controller is used to vary the intensity and frequency of stimulations, to achieve a lifting sensation throughout the pelvic floor.

The device is typically used in sessions. The number and frequency of advised sessions varies, but the treatment period is typically 6 to 12 weeks.

The aim of the procedure is to reduce symptoms associated with stress or urge urinary incontinence, as an adjunct to pelvic floor muscle exercises.

Outcome measures

King's Health Questionnaire (KHQ)

The KHQ is a validated instrument for measuring the quality of life of women with urinary incontinence. It consists of 30 questions, divided into 9 individually scored domains. The total score ranges from 0 to 100: a score of 100 represents the worst possible quality of life, and 0 represents the best possible quality of life.

International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)

The ICIQ Short Form is a questionnaire for evaluating the frequency, severity and impact on quality of life of urinary incontinence in men and women. It has 4 items (frequency of urinary incontinence, amount of leakage, overall impact of urinary incontinence, self-diagnostic item), with a total score ranging from 0 to 21. The score is divided into the following severity categories: slight (1 to 5), moderate (6 to 12), severe (13 to 18) and very severe (19 to 21).