Intravaginal electrical stimulation of the pelvic floor for women with urinary incontinence: a systematic review of randomized controlled trials.

Abstract

Urinary incontinence is defined as "the complaint of involuntary loss of urine" and affects approximately 40% of women. It is associated with morbidity and decrease in quality of life. Despite its prevalence, there are several challenges associated with its management and there is a need for nonsurgical treatment alternatives. This systematic review aimed to assess the effectiveness of intravaginal electrical stimulation in improving patient outcomes and quality of life. PubMed, EMBASE, Ovid Medline, and IEEE Xplore were searched up until February 2025. Randomized controlled trials focusing on intravaginal electrical stimulation against conservative (nonpharmacological and nonsurgical) or no treatment/placebo comparators for urinary incontinence were included. Article titles and abstracts were independently double-screened. The full text of eligible articles were retrieved and assessed for eligibility by at least 2 independent authors. Bias was assessed by 2 authors (R.R.W. and M.K.) using the Cochrane Risk of Bias Tool 2.0. Disputes were resolved through consensus. As a meta-analysis could not be performed due to trial quality limitations and heterogeneity, findings are presented in a narrative tabular form. Among 187 studies identified, 32 randomized controlled trials (17.1%) were eligible for inclusion. When reporting specific outcomes, 6/8 (75%) randomized controlled trials reported significant within-group reductions in the number of pads used for intravaginal electrical stimulation groups; 10/15 (66.7%) trials reported significant within-group reductions in pad weight for intravaginal electrical stimulation groups; and 8/14 (57.1%) trials reported significantly reduced leakage frequencies with significant differences between intravaginal electrical stimulation and passive treatment groups. Other bladder diary measurement findings were mixed. Increased pelvic floor muscle contraction strength, increased maximum cystometric capacity, decreased detrusor overactivity, and increased quality of life were observed, although the evidence is of low quality and lacks robustness. In the setting of randomized controlled trials, intravaginal electrical stimulation exhibited moderate-to-high adherence rates and a low risk and severity of adverse events. Intravaginal electrical stimulation may be a viable treatment for urinary incontinence. However, the present evidence base is of low quality to draw sufficient conclusions about its efficacy. Further multicentre, adequately powered and methodologically sound randomized controlled trials are needed.