(101) SHOCKWAVE THERAPY FOR THE TREATMENT OF POSTPARTUM STRESS URINARY INCONTINENCE: A PILOT STUDY
Authors: Kohut-Jackson A , Stanford D , Roberts S , Reale J , Watkins S , Rubin R 
Published: June 2024

Abstract

Introduction
Stress urinary incontinence (SUI) is estimated to affect approximately 15% of adult women. Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a form of electrohydraulic acoustic shockwave that has been shown to be effective in animal models of SUI. The Urogold100® is a Li-ESWT device that is FDA-cleared for improving blood flow, connective tissue activation, and pain relief, and it has been shown in multiple studies to be effective for mild to moderate erectile dysfunction and chronic pelvic pain in both men and women. While Li-ESWT has been investigated for related urologic conditions, minimal research exists as to its potential effectiveness for SUI in women.

Objective
Our aim was to evaluate the effectiveness of Li-ESWT for women with postpartum stress urinary incontinence in a pilot study.

Methods
Email recruitment was carried out in a single sexual medicine practice. Four women underwent weekly treatments with Li-ESWT for 4-6 weeks. All patients were postpartum women between ages 43-55. Treatment specifics included 1000 shocks at 2.5 Hz (initial visit) and 3.0 Hz (subsequent visits) distributed over the perineum and urethral opening. Energy level was based on patient tolerance, beginning with 0.06 Mj/mm2 and increased up to 0.08 Mj/mm2 for subsequent visits. Evaluation measures included the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Bladder Diary, both administered prior to treatment initiation and after treatment completion. The ICIQ-SF allowed patients to self-assess their urine leakage over the past several weeks (amount and frequency) while the Bladder Diary required patients to record specific leakage incidences throughout a single day.

Results
Prior to treatment initiation, patients reported 1-3 small daily urine leaks via the NIDDK Bladder Diary. All patients either improved or remained the same in this assessment post-treatment; all patients reported 1 small daily leak after treatment completion. Results from the subjective ICIQ-SF varied: 1 patient reported worsening from 1 daily leak to 2-3 daily leaks, which she attributed to increased water intake. Two patients reported improvements (several daily leaks to 1 weekly leak; several daily leaks to 2-3 weekly leaks). One patient reported no change. Subjective reporting from patients indicated 3 of the 4 felt the treatment was improving their symptoms, and the fourth patient reported no changes.

Conclusions
Our pilot study indicates that 3 of 4 patients showed improvements in their objective Bladder Diary recordings with reduced frequency of urine leakage, and 2 of 4 patients noted improvements in their subjective ICIQ-SF reporting. 3 of 4 provided positive verbal feedback as well. Despite the limited sample size, the improvements seen in the objective leakage frequency recordings are encouraging findings that warrant future investigation in a larger cohort. Given the noninvasive nature, ease of use, and high patient tolerability of Li-ESWT, this treatment modality should be considered for investigation in a larger cohort with the goal of relieving symptoms of SUI.

Disclosure
No.