PMS has been used as a non-surgical option for SUI since 1998 due to its established safety, automatic contractions, no discomfort from probe insertion into the vagina and easy to administer (machine-operated). A magnetic coil embedded in the QRS®-1010 PelviCenter magnetic stimulation device (Figure 1) generates pulsed magnetic fields which are able to penetrate deep into the pelvic floor muscles, causing repetitive strong contractions. In the active arm in our clinical trial, the treatment consisted of 16 sessions of active PMS (twice a week for eight weeks). Each 20-minute session comprised 100 repetitive contractions, leading to a total of 1600 contractions in 16 sessions. After 16 sessions, patients who were not satisfied with treatment outcome could opt for an additional 16 active PMS sessions. We compared the efficacy of different number of sessions (16 and 32 active PMS) versus sham group (0 active PMS) at one year post-treatment.
At one year post-treatment, using our primary criterion of response, a 5-point reduction in International Consultation on Incontinence Questionnaire for Urinary Incontinence-Short Form (ICIQ-UI SF) score, our results showed that subjects who received 32 sessions of active PMS had the highest percentage of treatment responders, followed by those who received 16 sessions and those who did not receive any active PMS (p<0.001). We also reported data on various objective and subjective outcome measures including objective and subjective cure rates, incontinence episode frequency, 1-hour pad test, pelvic floor muscle function measured using perineometer, incontinence severity improvement in ICIQ-UI SF category, Patient Global Impression of Improvement (PGI-I) and International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol).
We postulate that treatment efficacy was sustained even at one-year after discontinuing treatment because PMS helped patients regain pelvic floor muscle coordination and awareness. Stronger muscles meant patients were able to actively contract the muscles upon physical exertion. Based on the encouraging long-term response rates, we believe that PMS is an attractive non-surgical alternative for patients reluctant to undergo surgery.
Figure 1: Pulsed magnetic stimulation treatment using QRS®-1010 PelviCenter magnetic stimulation device
Written by Renly Lim, Men Long Liong, Wing Seng Leong, Kah Hay Yuen
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