الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 56 |  |  |
| | | from | 56 | | |
Abstract
Mixed urinary incontinence is a common under-reported problem among females. It has a major effect on patients’ quality of life. Questionnaire for female Urinary Incontinence Diagnosis is a valuable research instrument, as history is often the most important contributor to diagnosis. Women with MUI have more severe symptoms and do not respond well to treatment than others with only one type of UI. Conservative treatment is the first line of management. Pelvic floor muscle training is an efficient technique to improve symptoms of all types of UI by strengthen PFM and increase its endurance and power. It is highly recommended by the European Association of Urology 2018 updated guidelines on UI.
Biofeedback is commonly linked to PFMT for women with urinary incontinence. It aims at teaching patients how to do voluntary contraction of the pelvic floor muscles or to improve training performance, also to learn when to contract the muscles to prevent leakage, as well as assessment of the improvement of contraction over time. It seems to add benefit of psychological support as the patient becomes in direct contact with the health professional and becomes involved actively in the rehabilitation program leading to gain great therapeutic effect. The surged faradic current is used to enforce the effect of active exercise by improving the strength and vascularity of various groups of muscles including pelvic floor muscles.
Neuromodulation is the modulation of the physiologic behavior of the nerve by electrical stimulation. Most of the recent studies revealed that neuromodulation inhibits urge sensation without influence on the urethral resistance or detrusor muscle contraction. Most of the recent studies revealed that neuromodulation inhibits urge sensation without influence on the urethral resistance or detrusor muscle contraction but with modulation of spinal cord reflexes and brain centers. Different techniques of neuromodulation (Sacral neuromodulation, transcutaneous tibial neuromodulation, percutaneous tibial neuromodulation, and pudendal anogenital neuromodulation) seem to show similar effects although the stimulation occurs at different sites in the body
The aim of this work is to study the effectiveness of biofeedback-assisted PFMT and electrostimulation versus peripheral neuromodulation in the treatment of MUI among women.
The present study included 68 non-virgin female patients with MUI. Exclusion criteria were any patient had previous anorectal, genitourinary, and gynecological surgeries, traumatic perineal injury, history of radiotherapy, patients consuming drugs that affect lower urinary tract function, any neurological conditions that affect sphincteric function, patients with urinary tract infection or vaginitis, Patients with implanted cardiac pacemaker and defibrillator, patients with uncompensated heart disease or uncontrolled hypertension.
Patients were subjected to history taking, assessment questionnaires, clinical examination, manometric pressure assessment, pelvic floor electrophysiological study including pudendal somatosensory evoked potential, pudendal nerve motor conduction study, pudendo-anal reflex, needle electromyography of the external anal sphincter, puborectalis and external urethral sphincter muscles. Quantitative interference pattern analysis was done to all patients before and after the intervention including interference pattern amplitude, root mean square and number of turns/second. Patients were allocated randomly into three groups, group I received biofeedback-assisted pelvic floor muscle training and faradic electrical stimulation, group II received posterior tibial neuromodulation, and group III received anogenital neuromodulation.
In Conclusion, the main features of electrophysiological assessment of female patients with MUI were prolonged PNTML, delayed PAR, abnormal EMG findings in pelvic floor muscles in the form of denervation potentials, DROP out of motor unit action potentials (MUAPs) with increased polyphasicity and turns.
Biofeedback-assisted PFM training is as effective as posterior tibial neuromodulation and anogenital neuromodulation in the treatment of MUI among women. Pudendal neuropathy is a common finding in female patients with MUI.