The effect of bladder training, pelvic floor muscle training, or combination training on urodynamic parameters in women with urinary incontinence

The purpose of this study was to compare the effect of three conservative i nterventions: pelvic floor muscle training, bladder training, or both, on u rodynamic parameters in women with urinary incontinence. Two hundred four w omen with genuine stress incontinence (GSI) or detrusor instability with or without GSI (DI +/- GSI) participated in a two-site trial comparing pelvic floor muscle training, bladder training, or both. Patients were stratified based on severity of urinary incontinence, urodynamic diagnosis, and treat ment site, then randomized to a treatment group. All women underwent a comp rehensive standardized evaluation including multi-channel urodynamics at th e initial assessment and at the end of 12 weeks of therapy. Analysis of cov ariance was used to detect differences among treatment groups on urodynamic parameters. Post-treatment evaluations were available for 181 women. No di fferences were found among treatments on the following measurements: maximu m urethral closure pressure, mean urethral closure pressure, maximum Kegel urethral closure pressure, mean Kegel urethral closure pressure, functional urethral length, pressure transmission ratios, straining urethral axis, fi rst sensation to void, maximum cystometric capacity, and the MCC minus FSV. The effect of treatment did not differ by urodynamic diagnosis. Behavioral therapy had no effect on commonly measured urodynamic parameters. The mech anism by which clinical improvement occurs remains unknown. (C) 1999 Wiley- Liss, Inc.