***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Pelvic floor electrical stimulation ( PFES ) has been shown to be effective for stress incontinence . However , its role in a multicomponent behavioral training program has not been defined . OBJECTIVE To determine if PFES increases efficacy of behavioral training for community-dwelling women with stress incontinence . DESIGN AND SETTING Prospect i ve r and omized controlled trial conducted from October 1 , 1995 , through May 1 , 2001 , at a university-based outpatient continence clinic in the United States . PATIENTS Volunteer sample of 200 ambulatory , nondemented , community-dwelling women aged 40 to 78 years with stress or mixed incontinence with stress as the predominant pattern ; stratified by race , type of incontinence ( stress only vs mixed ) , and severity ( frequency of episodes ) . INTERVENTIONS Patients were r and omly assigned to 8 weeks ( 4 visits ) of behavioral training , 8 weeks ( 4 visits ) of the behavioral training plus home PFES , or 8 weeks of self-administered behavioral treatment using a self-help booklet ( control condition ) . MAIN OUTCOME MEASURES Primary outcome was percentage reduction in the number of incontinent episodes as documented in bladder diaries . Secondary outcomes were patient satisfaction and changes in quality of life . RESULTS Intention-to-treat analysis showed that incontinence was reduced a mean of 68.6 % with behavioral training , 71.9 % with behavioral training plus PFES , and 52.5 % with the self-help booklet ( P = .005 ) . In comparison with the self-help booklet , behavioral training ( P = .02 ) and behavioral training plus PFES ( P = .002 ) were significantly more effective , but they were not significantly different from each other ( P = .60 ) . The PFES group had significantly better patient self-perception of outcome ( P<.001 ) and satisfaction with progress ( P = .02 ) . Significant improvements were seen across all 3 groups on the Incontinence Impact Question naire but with no between-group differences . CONCLUSIONS Treatment with PFES did not increase effectiveness of a comprehensive behavioral program for women with stress incontinence . A self-help booklet reduced incontinence and improved quality of life but not as much as the clinic-based programs In a prospect i ve r and omized study the efficiacy of physical therapy in female stress incontinence could be verified . The greatest success rate was achieved by medical gymnastics , whereas the perineal electrical stimulation should be used as supporting measure like a biofeedback mechanism because of its low effective intensity . Despite of the good therapeutic success ( 51.5 % ) with lasting effects no objective criteria to the use of physical therapy in female stress incontinence were found Purpose This study assessed the benefit of adding behavioural modification to darifenacin treatment for overactive bladder ( OAB ) . Material s and methods The ABLE trial was a r and omised , open-label , parallel-group , multicentre study of 12 weeks of darifenacin treatment [ with voluntary up-titration from 7.5 mg once daily ( qd ) to 15 mg qd at week 2 ] alone or in combination with a Behavioural Modification Programme ( BMP ) for men and women with dry or wet OAB .  Efficacy was assessed as the change in the number ( per day ) of micturitions ( primary variable ) , urge urinary incontinence ( UUI ) episodes , urgency episodes , pads used and nocturnal voids . Health-related quality of life ( HRQoL ) was also evaluated . Tolerability and safety assessment s included adverse events and the number of discontinuations . Results Of 592 patients screened , 395 were r and omised , 190 to darifenacin alone and 205 to darifenacin + BMP .  At baseline , the majority of subjects were dry ( mean 2.8 and three UUI episodes per day in the darifenacin and darifenacin + BMP groups respectively ) . At study end , darifenacin alone and darifenacin + BMP both produced significant reductions from baseline in median numbers of micturitions , UUI episodes , urgency episodes and nocturnal voids ( all p < 0.05 ) , but not in the number of pads used . HRQoL also improved . There were no significant differences between treatment groups in efficacy or HRQoL variables . Conclusions Darifenacin treatment provides a degree of normalisation of micturition variables and improvement in HRQoL that can not be further enhanced by behavioural therapy of the type used in this study . Whether behavioural modification would add benefit over darifenacin treatment in patients with more pronounced incontinence problems remains to be determined The objectives of this paper were to assess the quality of life of community-living women with urinary incontinence according to age , symptom group , amount of leakage , and duration , by use of the Sickness Impact Profile ( SIP ) .  Thirty-six women aged between 40 and 60 years and 40 women aged 70 years or more were r and omly selected from the clients attending an incontinence clinic and interviewed using the SIP question naire . Urge and stress incontinence subgroups were defined by means of a symptom question naire . Total , psychosocial , and physical dysfunctions were moderate ( 8 % , 7 % , and 8 % respectively ) in general , but major differences were found when age and symptom groups were analysed . Urge symptoms were associated with more impairment than symptoms of stress incontinence . The elderly women with symptoms of stress incontinence were relatively little affected , while their younger counterparts were severely affected , especially in the categories of emotional behavior and recreation and pastimes . We conclude that urinary incontinence in women adversely affects quality of life to a significant degree ; the extent depends on the nature of incontinence and the age of the person The purpose of this study was to explore changes in psychological distress associated with behavioral treatment and drug treatment for urge incontinence in community-dwelling older women . Participants were 197 ambulatory , nondemented women ( aged 55 years or older ) with persistent urge urinary incontinence . Participants were patients in a r and omized clinical trial comparing biofeedback-assisted behavioral treatment , drug treatment with oxybutynin chloride , and a placebo-control condition .  Psychological distress was measured before and after treatment using the Hopkins Symptom Checklist ( SCL-90-R ) . Multivariate and univariate analyses of variance showed that the two treatment groups and the control group had similar significant improvements on the nine subscales and the global severity index . Analysis of individual SCL-90-R subscale scores revealed trends suggesting that behavioral treatment tended to produce the largest improvements . The reductions of distress were not correlated consistently with reduction of incontinence . The results of this study showed that psychological distress was significantly reduced after treatment , regardless of the type of treatment ABSTRACT Objective To determine the efficacy of stress urinary incontinence treatments adding pelvic floor muscle training to vaginal electrical stimulation . Methods Forty-eight women with stress urinary incontinence were r and omized into 2 groups : 24 underwent isolated vaginal electrical stimulation , and 24 vaginal electrical stimulation plus pelvic floor muscle training .  History , physical examination , voiding diary , perineum strength test , and urodynamic study were assessed . Comparisons were made for adherence to treatment , muscle strength improvement , urinary symptoms , and degree of satisfaction immediately , 12 and 96 months after treatment . Results Patients ' degree of satisfaction on vaginal electrical stimulation , and on vaginal electrical stimulation plus pelvic floor muscle training immediately , 12 and 96 months post treatment , were , respectively : 88.2 % versus 88.9 % 64.7 % versus 61.1 % and 42.9 % versus 28.6 % ( p>0.05 ) . Conclusion Vaginal electrical stimulation associated to pelvic floor muscle training did not show better results than vaginal electrical stimulation alone Introduction and hypothesisThe aim of the study was to determine whether successful incontinence pessary fitting or pessary size can be predicted by specific POPQ measurements in women without advanced pelvic organ prolapse . Methods In a multicenter study , women with stress urinary incontinence ( SUI ) and POPQ stage ≤2 were r and omized to three treatment arms : ( 1 ) incontinence pessary , ( 2 ) behavioral therapy , or ( 3 ) both . This study evaluates incontinence pessary size , POPQ measures , and successful fitting in the 266 women assigned to treatment arms 1 and 3 . Results Two hundred thirty-five women ( 92 % ) were successfully fitted with an incontinence ring ( n = 122 ) or dish ( n = 113 ) . Hysterectomy , genital hiatus ( GH ) , and GH/total vaginal length ( TVL ) ratios did not predict unsuccessful fitting ( p > 0.05 ) . However , mean TVL was greater in women successfully fitted ( 9.6 vs. 8.8 cm , p < 0.01 ) . Final pessary diameter was not predicted by TVL , point D , or point C ( p > 0.05 ) . Conclusions The vast majority of women with SUI can be successfully fitted with an incontinence pessary , but specific POPQ measures were not helpful in determining incontinence pessary size A r and omized controlled trial was carried out to evaluate the extent to which a program of reinforced pelvic floor muscle exercises ( PFME ) reduces urinary incontinence 1 year after delivery . Two hundred and thirty women who were incontinent 3 months postpartum were r and omized to either a control group doing st and ard postnatal pelvic floor muscle exercises ( n=117 ) or to an intervention group ( n=113 ) who saw a physiotherapist for instruction at approximately 3 , 4 , 6 and 9 months postpartum . Results collected 12 months after delivery included prevalence and frequency of incontinence and PFME , sexual satisfaction , perineometry measurements and pad tests . Twenty-six ( 22 % ) of the control group and 59 ( 52 % ) of the intervention group withdrew before the final assessment . The prevalence of incontinence was significantly less in the intervention group than in the control group ( 50 % versus 76%,P=0.0003 ) , and this group also did significantly more PFME . There were no significant differences between the groups as regards sexual satisfaction , perineometry measurements or pad test results Objective : To evaluate a new pattern of electrical of electrical stimulation as a treatment for stress incontinence . Design : A r and omized , double-blind , controlled trial . Setting : The study took place on three clinical sites . Subjects : Patients ( n= 27 ) with urodynamically proven stress incontinence recruited via consultant referral . Interventions : Patients were r and omly allocated to one of two groups : the new pattern of stimulation or sham stimulation . Main outcome measures : Patients were assessed pre , mid and post treatment using :  perineometry , digital assessment and pad testing . The following were only used pre and post treatment : seven-day frequency/ volume chart , SF-36 , the Incontinence Impact Question naire and the Urogenital Distress Inventory . Results : No significant between-group differences were highlighted except when quality of life was assessed with the Urogenital Distress Inventory ( p= 0.01 ) . A significant reduction in scores was observed in the stimulation group ( p= 0.03 ) However , improvements were seen in both the strength and endurance characteristics of the pelvic floor musculature , although these changes were not translated into a reduction in symptoms . Conclusion : Although promising , the improvement in pelvic floor function did not result in a reduction in symptoms in all patients . Further research is required to investigate the effects of the new stimulation in combination with pelvic floor exercises and to compare the new stimulation pattern with existing forms of electrical stimulation PURPOSE We tested whether individualized drug therapy enhanced with behavioral training would result in better outcomes than individualized drug therapy alone . MATERIAL S AND METHODS Participants were community dwelling women with urge predominant incontinence . Using a r and omized clinical trial design women were r and omized to 8 weeks ( 4 visits ) of drug therapy alone ( 32 ) or drug therapy plus behavioral training ( 32 ) . Drug therapy was individually titrated , extended release oxybutynin with proactive management of side effects . Behavioral training included pelvic floor muscle training and urge suppression techniques . The primary outcome measure was reduction in frequency of incontinence episodes on bladder diary at 8 weeks ( with followup at 6 and 12 months ) . Secondary outcomes included patient satisfaction , global perception of improvement , Urogenital Distress Inventory and Incontinence Impact Question naire . RESULTS In intent to treat analysis frequency of incontinence was reduced a mean of 88.5 % in the drug alone group and 78.3 % in the combined therapy group ( p = 0.16 ) . Outcomes were not significantly different between the groups in the analysis of completers ( 91.5 % vs 86.2 % , p = 0.34 ) , or in either analysis at 6 or 12 months . The groups also did not differ significantly on secondary outcomes at any point . Participants in the drug alone group tended to be taking higher doses of  oxybutynin at 8 weeks but the final dose did not differ significantly between the groups . Based on a conditional power calculation the trial was stopped early for futility . CONCLUSIONS When drug therapy is implemented with frequent individualized dose titration , daily bladder diaries and careful management of side effects , initiating concurrent behavioral training does not enhance outcomes for urge incontinence in women OBJECTIVES We previously reported high rates of urinary incontinence among gynecologic cancer survivors and aim ed to evaluate the effectiveness of a simple intervention for 
    Output:
    
This systematic review found insufficient evidence to state whether or not there were additional effects by adding PFMT to other active treatments when compared with the same active treatment alone for urinary incontinence ( SUI , UUI or MUI ) in women .
Also , none of the included trials reported data on adverse events associated with the PFMT regimen , thereby making it very difficult to evaluate the safety of PFMT