The Efficacy of Intravaginal Electrical Stimulation in Women With Idiopathic Overactive Bladder
Primary Purpose
Urinary Bladder, Overactive
Status
Recruiting
Phase
Not Applicable
Locations
Turkey
Study Type
Interventional
Intervention
intravaginal electrical stimulation added to bladder training
Sponsored by
About this trial
This is an interventional treatment trial for Urinary Bladder, Overactive focused on measuring bladder training, intravaginal electrical stimulation
Eligibility Criteria
Inclusion Criteria:
- Over the age of 18 with the clinical diagnosis of idiopathic OAB
- Who could able to give written informed consent and understand the procedures
Exclusion Criteria:
- Women who had stress urinary incontinence
- A history of conservative therapy (BT, ES) for OAB within 6 months
- Urogynecological surgery within 3 months
- Current vulvovaginitis or urinary tract infections or malignancy
- Pregnancy
- Cardiac pacemaker or implanted defibrillator
- Anatomic structural disorders of the genital region that did not allow to apply the vaginal probe
- The strength of PFM less than 3/5 (graded as modified Oxford scale, min:0-max:5)
- The pelvic organ prolapse quantification (POP-Q) (stage 2 or more)
- Neurogenic bladder
- The peripheral or central neurologic pathology
- Ultrasonographic evidence of post-void residual urine volume more than 100 ml
- Allergy to condom or lubricant gel that is used with vaginal probe
Sites / Locations
- Pamukkale UnivercityRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Active Comparator
Arm Label
Antimuscarinic Naive (AM-N)
Antimuscarinic Refractory (AM-R)
Arm Description
None of the women had previously taken anti-muscarinic agents and oral ß3 adrenoreceptor agonist (mirabegron) in this group.
Women with idiopathic OAB refractory to anti-muscarinic agents and oral ß3 adrenoreceptor agonist (mirabegron) when 2 or more were administered for at least 6 weeks each and failure was due to lack of efficacy with or without side effects were included in this group.
Outcomes
Primary Outcome Measures
Incontinence episodes (positive response rate)
To determine positive response rate, reduction in incontinence episodes was collected from the 3-day bladder diary. Women with ≥a 50% reduction in incontinence episodes were considered positive responders.
Secondary Outcome Measures
the severity of incontinence
The 24-hour pad test was carried out to evaluate the severity of incontinence .
symptom severity
Overactive Bladder Questionnaire (OAB-V8) was used to evaluate the symptom severity in patients with OAB in this study. The OAB-V8 consists of 8 questions in which the patients can be classified with respect to the symptom severity: none (0), very little (1), a little (2), quite a few (3), very (4), and too many (5). The total score ranges from 0-40.
frequency of voiding
The frequencies of voiding, nocturia, and the number of pads used were collected from the 3-day bladder diary.
nocturia
The frequencies of voiding, nocturia, and the number of pads used were collected from the 3-day bladder diary.
number of pads
The frequencies of voiding, nocturia, and the number of pads used were collected from the 3-day bladder diary.
quality of life (QoL)
The Quality of Life-Incontinence Impact Questionnaire (IIQ7) was used to assess specific QoL related to incontinence. Minimum score is 0, maximum score is 21 and high scores mention worse outcome.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT05416450
Brief Title
The Efficacy of Intravaginal Electrical Stimulation in Women With Idiopathic Overactive Bladder
Official Title
Comparison of the Efficacy of Intravaginal Electrical Stimulation in Antimuscarinic Naive and Refractory Women With Idiopathic Overactive Bladder
Study Type
Interventional
2. Study Status
Record Verification Date
October 2022
Overall Recruitment Status
Recruiting
Study Start Date
July 1, 2022 (Actual)
Primary Completion Date
December 15, 2022 (Anticipated)
Study Completion Date
January 5, 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Pamukkale University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
In this study, it was aimed to compare the effectiveness of intravaginal electrical stimulation (IVES) added to bladder training (BT) on quality of life (QoL) and clinical parameters related to overactive bladder (OAB) in antimuscarinic naive and refractory women. The results of this study would make it easier to understand the place of IVES among the treatment options in women with idiopathic OAB.
Detailed Description
Overactive bladder (OAB) is a symptom complex defined as urgency, with or without urgency urinary incontinence (UUI), usually with frequency and nocturia in the absence of urinary tract infection. Some authors listed the treatment options in idiopathic OAB as follows; first-line - behavioral therapy (lifestyle modifications, pelvic floor muscle (PFM) training, bladder training (BT), timed voiding), second-line - pharmacologic (antimuscarinic, beta-3 agonists), and third-line - neuromodulation/chemodenervation (tibial nerve stimulation, sacral neuromodulation, intradetrusor botulinum toxin). Intravaginal electrical stimulation (IVES) is involved in pelvic floor muscle training as a first-line treatment option. On the contrary, some authors stated that "the first-line treatment of idiopathic OAB includes behavior modification and physical therapy, and neuromodulation methods are used as third-line therapy in cases refractory to first-line and second-line (pharmacological) treatment. IVES, tibial nerve stimulation, and sacral neuromodulation are included as neuromodulation options". However, it is known that many patients with idiopathic OAB receive pharmacological treatment before reaching a conservative treatment option such as IVES. In common practice, antimuscarinic agents are frequently used as an initial treatment although burdened by a low adherence, and these patients need protracted treatment with periodic controls.
Some studies included subjects were not used antimuscarinics within the last 4-12 weeks or antimuscarinic-naive patients with OAB, while some included patients with OAB who were unresponsive or intolerant to antimuscarinics. As a result, IVES appear to be effective therapies used both as first-line treatment, as well as in managing refractory patients with idiopathic OAB. There is no evidence that it is most effective in which patients (antimuscarinic naive and refractory). Would it be more effective on the first-line or the third-line? or in other words; is there a difference in response to IVES in antimuscarinic naive and refractory patients with OAB? It should be kept in mind that IVES may lead to different results in antimuscarinic naive and refractory patients with idiopathic OAB. This study is the first prospective trial that compares the efficacy of IVES in antimuscarinic naive and refractory women with idiopathic OAB. In this study, it was aimed to compare the effectiveness of IVES added to BT on quality of life (QoL) and clinical parameters related to OAB in antimuscarinic naive and refractory women. The results of this study would make it easier to understand the place of IVES among the treatment options in women with idiopathic OAB.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Urinary Bladder, Overactive
Keywords
bladder training, intravaginal electrical stimulation
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Non-Randomized
Enrollment
48 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Antimuscarinic Naive (AM-N)
Arm Type
Active Comparator
Arm Description
None of the women had previously taken anti-muscarinic agents and oral ß3 adrenoreceptor agonist (mirabegron) in this group.
Arm Title
Antimuscarinic Refractory (AM-R)
Arm Type
Active Comparator
Arm Description
Women with idiopathic OAB refractory to anti-muscarinic agents and oral ß3 adrenoreceptor agonist (mirabegron) when 2 or more were administered for at least 6 weeks each and failure was due to lack of efficacy with or without side effects were included in this group.
Intervention Type
Device
Intervention Name(s)
intravaginal electrical stimulation added to bladder training
Intervention Description
BT was given as a home program. After information session, squeezing the PFM was shown in practice at least once to use in the urgency suppression strategies via digital palpation technique. The second stage strategies was aimed to delay urination, inhibit detrusor contraction, and prevent urgency by squeezing the PFM several times on a row, breathing deeply and self-motivating. In the third stage, a timed voiding program was started; a timed voiding and increasing the time between urination considering the voiding diary. IVES was applied in addition to BT in both groups. It was performed in lithotomy position via a stimulation device (Enraf Nonius Myomed 632) with a vaginal probe; three days a week, a total of 24 sessions for 8 weeks. Every session lasted 20 minutes. The stimulation parameters were a 10 Hz of frequency, a 5-10 s of work-rest cycle duration and, a 100 ms of pulse width. The symmetric biphasic pulse wave could be delivered over a range of 1-100 mA.
Primary Outcome Measure Information:
Title
Incontinence episodes (positive response rate)
Description
To determine positive response rate, reduction in incontinence episodes was collected from the 3-day bladder diary. Women with ≥a 50% reduction in incontinence episodes were considered positive responders.
Time Frame
Change from baseline at the 8th week after the treatment
Secondary Outcome Measure Information:
Title
the severity of incontinence
Description
The 24-hour pad test was carried out to evaluate the severity of incontinence .
Time Frame
Change from baseline at the 8th week after the treatment
Title
symptom severity
Description
Overactive Bladder Questionnaire (OAB-V8) was used to evaluate the symptom severity in patients with OAB in this study. The OAB-V8 consists of 8 questions in which the patients can be classified with respect to the symptom severity: none (0), very little (1), a little (2), quite a few (3), very (4), and too many (5). The total score ranges from 0-40.
Time Frame
Change from baseline at the 8th week after the treatment
Title
frequency of voiding
Description
The frequencies of voiding, nocturia, and the number of pads used were collected from the 3-day bladder diary.
Time Frame
Change from baseline at the 8th week after the treatment
Title
nocturia
Description
The frequencies of voiding, nocturia, and the number of pads used were collected from the 3-day bladder diary.
Time Frame
Change from baseline at the 8th week after the treatment
Title
number of pads
Description
The frequencies of voiding, nocturia, and the number of pads used were collected from the 3-day bladder diary.
Time Frame
Change from baseline at the 8th week after the treatment
Title
quality of life (QoL)
Description
The Quality of Life-Incontinence Impact Questionnaire (IIQ7) was used to assess specific QoL related to incontinence. Minimum score is 0, maximum score is 21 and high scores mention worse outcome.
Time Frame
Change from baseline at the 8th week after the treatment
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Over the age of 18 with the clinical diagnosis of idiopathic OAB
Who could able to give written informed consent and understand the procedures
Exclusion Criteria:
Women who had stress urinary incontinence
A history of conservative therapy (BT, ES) for OAB within 6 months
Urogynecological surgery within 3 months
Current vulvovaginitis or urinary tract infections or malignancy
Pregnancy
Cardiac pacemaker or implanted defibrillator
Anatomic structural disorders of the genital region that did not allow to apply the vaginal probe
The strength of PFM less than 3/5 (graded as modified Oxford scale, min:0-max:5)
The pelvic organ prolapse quantification (POP-Q) (stage 2 or more)
Neurogenic bladder
The peripheral or central neurologic pathology
Ultrasonographic evidence of post-void residual urine volume more than 100 ml
Allergy to condom or lubricant gel that is used with vaginal probe
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Burak Unal, M. D.
Phone
+905466033240
Email
burakunal_3293@hotmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Necmettin Yıldız, Prof
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Necmettin Yıldız, Prof
Organizational Affiliation
Pamukkale University
Official's Role
Study Director
Facility Information:
Facility Name
Pamukkale Univercity
City
Denizli
Country
Turkey
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Necmettin Yıldız
12. IPD Sharing Statement
Learn more about this trial
The Efficacy of Intravaginal Electrical Stimulation in Women With Idiopathic Overactive Bladder
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