Review question

We investigated whether electrical stimulation was better than no treatment at all or better than other available treatments for curing or improving stress urinary incontinence (SUI) symptoms in women. We also investigated whether SUI was cured or improved by adding electrical stimulation to other treatments, compared to other treatments and to different types of electrical stimulation. Finally, we investigated whether electrical stimulation represented value for money.

Background

About 25% to 45% of women worldwide have problems with leaking urine involuntarily. Women with SUI often leak urine with physical exertion such as coughing or sneezing. SUI can be treated with pelvic floor muscle exercises, vaginal cones, drug therapy or surgery, but there are various problems with these treatments. A possible alternative is electrical stimulation with non-implanted devices, whereby an electrical current is delivered through vaginal electrodes.

How up-to-date is this review?

We searched for studies that had been published up to 27 February 2017.

Study characteristics

We found 56 trials (involving a total of 3781 women, all with stress urinary incontinence but some with urgency urinary incontinence as well) comparing electrical stimulation to no treatment or to any other available treatment.

Key results

For cure or improvement of SUI, electrical stimulation was probably better than no active or sham treatment. There was not enough evidence to say whether it was any better than pelvic floor muscle training for curing or improving SUI, or for quality of life. Adding electrical stimulation to pelvic floor muscle training may not make much difference to cure or improvement of SUI. It is uncertain whether it offers any improvement in quality of life compared with pelvic floor muscle training.

We found that few women reported adverse effects with electrical stimulation, but there was not enough reliable evidence comparing electrical stimulation to other treatments to know more about its safety.

There was not enough evidence comparing electrical stimulation to other existing treatments such as drug therapy, pelvic floor muscle training plus vaginal cones, surgery, or different forms of electrical stimulation, to provide evidence-based guidance on which would be better, and for which women, in curing or improving SUI or in improving quality of life. There was no information from these studies to judge value for money.

Quality of the evidence

There is some evidence to support the use of electrical stimulation for stress urinary incontinence in women, but we are still very uncertain about the full potential of this treatment because of the low quality of the existing evidence. While we found evidence indicating that electrical stimulation may be better than no treatment, we did not find enough well-designed trials with enough women to fully answer our review questions, so we do not yet know if ES is better or worse than other treatments.