Doha, March 12th 2008 The magic magnetic chair- how to facilitate best Daniela Marschall-Kehrel, Frankfurt

What is evidenced based medicine? SUI post RPx: 2 Publications Mixed incontinence in both genders SUI/Qol IC/CPPS (females) SUI in females Sexual performance in women CPPS/chronic prostatitis III NIDDKD

SUI post RPx; PFMT vs MFT: n=105, 2 arms no cross over Start 1 week after catheter was removed (16.8=dry). MFT 2x20weeks 30‘ follow- up: 4 weeks, 3, 6+12mo. Continence –I: 51%, 64%, 82% –II: 44%, 50%, 68% Pad test I=p=0.004 after 12mo Qol significantly better (no numbers)

Mixed incontinence both genders n=49 24=active 25=placebo 3x6weeks; 1st: intermitt. 5Hz 10‘, 3‘rest 2nd: intermitt 50Hz 10‘; follow-up: 8weeks. Only active=14 and placebo=19 eligable SUI: –Active: pad test significant p=0.002 –Placebo: worse 47% to 68% OAB: –Urgency: active p=0.09 –Wet: active=0 (21% before), placebo=no change Pad weight –Active: mean 2.59g p=0.079 –Placebo: mean Qol –Active: p=0.04 –Placebo: p=0.56

UI 3mo post RPx n=27 11=active, 16=placebo 2x6weeks sham pat. had cross over 6wks Pads/day – 1.41 to % p>0.04; 6/9=continent –Cross over 1.89 to 1.17 Incontinence episodes –3.42 to % p>0.01 Pad weight – 4.81 to 3.81 p>0.03 –Cross over 5.78 to 1.5 p>0.05 Qol positive trends

SUI-Qol women n=66 2x6weeks 1st: 5Hz 10‘ 2nd: 50Hz 10‘ Qol –53/66 80% p=0.01 improved Incontinece episodes 40/53 0<0.01 Pad changes 46/53 p<0.01 –12/66 decreased Qol Incontinence episodes 4/12 p>0.05 Pad changes 5/12 p>0.05 Urinary frequency –20/33 decreased p=0.002 –13/33 increased p missing

IC/CPPS treatment failures n=10, investigator initiated trial 2x8weeks maximum voltage therapy 9/10 improved frequency, pain, urgency 3/10 total relief of symptoms but not long lasting 1/10 failed

SUI females n=64, follow-up 3mo n=51 2x6weeks Incontinence –18/51 34% continent Pad/day –1/day 16/51 32% 2.5 to 1.3 p=0.001 Leak episodes –3.3 to 1.7 p=0.001 UD –ALLP 43 to 48 cmH2O –DO 5/51 to 1/51 p= month follow-up n=36 –10/36 28% continent –8/36 22% 1 pad/day

Orgasmic performance in women n=20, 7/20 not sexual activ OAB wet questionaire(6 questions) n=13 6/13 no changes 2/13 worse 5/13 improved Age was most reliable (<55ys)

CPPS III NIDDKD treatment failures n=21 11=activ 10=placebo 2x4weeks 1st: cont.10Hz 15‘ 2nd: cont.50Hz 15‘ follow-up 3mo and 1y Pain score –3mo p<0.05 –1y p<0.05 Urinary symptom score –3mo p<0.05 –1y not significant

From theory to Practise

SUI Intermitt Hz 20‘ 100% 3x4-6wk +/- Duloxetin

OAB Intermitt Hz 20‘ 100% 3x4wk Antimuscarinics?

CPPS/IC Diclofenac 100mg Supp 10‘ before treatment 1st: intermitt Hz 50% 15‘min 3- 5x4weeks 2nd: cont. 5Hz 100% 15‘ see above

ED PGE5I cont., SCAT in TF? 1st: intermitt Hz 15‘ 3x4weeks 2nd:intermitt Hz 15‘ s.a.

SUI after RPx Intermitt Hz 100% 3-5x 4weeks If OAB: intermitt Hz 100% 3x4wks

CPPS/chronic Prostatitis Ciproflox 200 iv 5‘ before start MFT and 500mg evening dosage; if pain is dominant add Diclofenac 100mg Supp 10‘ before treatment Intermitt Hz 55% daily 5-10 days If pain: cont. 5Hz 100% 10‘/break 2‘/10‘ 3-5/week

No personal experience Fecal incontinence Ogasmproblems Ejaculationpower Acute pain Muscle volume