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PAPERS: Kari Bø, Trygve Talseth, and Ingar Holme Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women BMJ 1999; 318: 487-493 [Abstract] [Full text]

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Onset of benefit.

S Satya Murti   (20 February 1999)

Untitled

Malcolm John Dickson   (19 March 1999)

Onset of benefit. 20 February 1999
S Satya Murti, Medicare Medical Director Topeka, Kansas, USA. Send response to journal: Re: Onset of benefit.	I find this article useful; its methodological rigor lends credibility to the results. Here are my questions for the authors. When did the benefits commence in each of the groups? Did the outcome measures, especially the muscle strength and subjective perception, reveal a trend before the 6 month period? Did pelvic floor muscle training group receive training weekly for the entire 6 month period? In some public-funded programs, this could become a resource-intensive intervention. If benefit onset could be timed to an earlier period, then weekly training sessions may be delegated to phone-based contact and reinforcement. Thank you.
Untitled 19 March 1999
Malcolm John Dickson Send response to journal: Re: this article	Editor Bo et al (1) report treatment with pelvic floor exercises results in a subjective cure rate of 56% in women with urodynamically demonstrated genuine stress incontinence. They question if this is satisfactory and conclude that it is. I cannot but agree with this as women are spared the need for surgery and avoid its associated morbidity. What would be useful is a predictive method of determining who would benefit from pelvic floor exercises and those that wouldn't and would require surgical intervention. Intuitively one feels this would be based upon the extent of urinary leakage, but there is a lack of reproducible and valid tests to measure urinary leakage. Until such time, if ever, reproducible tests are available, it seems appropriate that all women with genuine stress incontinence should be offered pelvic floor exercises as initial treatment for genuine stress incontinence and only those without a satisfactory response should be offered surgical treatment. I have the honor to remain, Sir, Your obedient servant. Malcolm John Dickson 1 Bo K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones and no treatment in the management of genuine stress incontinence in women. BMJ 1999;318:487-93 Correspondence to: Dr Malcolm John Dickson, Dept of Obstetrics & Gynaecology, Hope Hospital, Salford, Lancashire M6 8HD