Electrical Stimulation and Magnetic Stimulation

With respect to lower urinary tract dysfunctions, electrical stimulation (ES) is applied, particularly to the pelvic floor muscles, bladder, and sacral nerve roots. The ES of the pelvic floor aims at stimulating motor fibres of the pudendal nerve, which may elicit a direct contraction of the pelvic floor muscles or the striated peri-urethral musculature, supporting the intrinsic part of the urethral sphincter closing mechanism. Also, it has been suggested that ES restores continence by inhibiting reflex contraction of the bladder. Today, it is still very difficult to clarify the potential value and benefits of ES in the treatment of urinary incontinence, the most prevalent form of lower urinary tract dysfunction. It is questionable whether or not ES may be a first-choice conservative treatment option or would have any additional value to functional training in patients with stress urinary incontinence. There is some evidence showing that ES has potential in patients with overactive bladder symptoms. Magnetic stimulation is also a treatment option for patients with lower urinary tract dysfunctions, but, although some positive results have been reported, convincing evidence based on high-quality scientific studies is still lacking. This chapter will discuss the biological rationale, choice of stimulation parameters, and the current state of evidence for electrical and magnetic stimulation.