Électrostimulation et rééducation périnéale de l’incontinence urinaire et des troubles mictionnels non neurologiques

RésuméL’électrostimulation, classique ou neuromodulation, est une technique efficace de traitement de l’incontinence urinaire et des troubles mictionnels non neurologiques. Les études cliniques de la littérature ont objectivé des effets positifs cliniques et urodynamiques, y compris les études randomisées en double insu contre placébo, qui restent peu nombreuses au regard des multiples études cliniques ouvertes de niveau de preuve faible. Surtout, il a été objectivé que la meilleure efficacité existait lorsque cette technique était associée à un programme complet de rééducation (prise de conscience, travail musculaire actif du périnée, biofeed-back, autoentretien à domicile), dans lequel elle s’intègre parfaitement. Cela témoigne de la complexité des troubles et de la nécessité d’un bilan clinique et urodynamique soigneux pour préciser au mieux leur physiopathologie.

A literature survey of 106 articles shows that standard electrostimulation is an effective treatment of urinary incontinence and urinary disorders with bladder instability. Bladder inhibition is obtained by applying an alternating current at a frequency of between 5 and 25 Hz and with a pulse width of between 0.2 and 0.5 ms. In 19 articles (including three randomized, placebo-controlled studies), good results were achieved in 60 to 90% of cases, depending on the exact method (i.e. chronic or acute stimulation). Standard electrostimulation is also efficient in stress urinary incontinence. Urethral closure is obtained by applying a 50 Hz alternating current with, again, a pulse width of between 0.2 and 0.5 ms. In 21 articles (including two randomized, placebo-controlled studies), good results were achieved in 47.5 to 77% of cases. Treatments combining perineal rehabilitation (behavioural education, muscle improvement and biofeed-back) and electrostimulation are reported by 10 authors, with good results in 70 to 80% of cases after 10 to 12 sessions. According to 14 studies, neuromodulation is also an efficient treatment for complex urinary disorders, urgency, pollakiuria and dysuria. The recommended stimulation parameters are a frequency of 10 to 15 Hz and a pulse width of 210 ms. Good results were found in 34 to 94% of cases (with between 60 and 75% in an international, multicenter study). The overall results different from one study to another because of the need to harmonize stimulation parameters, choice of the study population and treatment follow-up with self-training programs and therapeutic education.