***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 
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    Input: Abstract Objective : To compare the effect of pelvic floor exercises , electrical stimulation , vaginal cones , and no treatment for  genuine stress incontinence . Design : Stratified , single blind , r and omised controlled trial . Setting : Multicentre . Participants : 107 women with clinical ly and urodynamically proved genuine stress incontinence . Mean ( range ) age was 49.5 ( 24 - 70 ) years , and mean ( range ) duration of symptoms 10.8 ( 1 - 45 ) years . Interventions : Pelvic floor exercise ( n=25 ) comprised 8 - 12 contractions 3 times a day and exercise in groups with skilled physical therapists once a week . The electrical stimulation group ( n=25 ) used vaginal intermittent stimulation with the MS 106 Twin at 50 Hz 30 minutes a day . The vaginal cones group ( n=27 ) used cones for 20 minutes a day . The untreated control group ( n=30 ) was offered the use of a continence guard . Muscle strength was measured by vaginal squeeze pressure once a month . Main outcome measures : Pad test with st and ardised bladder volume , and self report of severity . Results : Improvement in muscle strength was significantly greater ( P=0.03 ) after pelvic floor exercises ( 11.0 cm H2O ( 95 % confidence interval 7.7 to 14.3 ) before v 19.2 cm H2O ( 15.3 to 23.1 ) after ) than either electrical stimulation ( 14.8 cm H2O ( 10.9 to 18.7 ) v 18.6 cm H2O ( 13.3 to 23.9 ) ) or vaginal cones ( 11.8 cm H2O ( 8.5 to 15.1 ) v 15.4 cm H2O ( 11.1 to 19.7 ) ) . Reduction in leakage on pad test was greater in the exercise group ( −30.2 g ; −43.3 to 16.9 ) than in the electrical stimulation group ( −7.4 g ; −20.9 to 6.1 ) and the vaginal cones group ( −14.7 g ; −27.6 to −1.8 ) . On completion of the trial one participant in the control group , 14 in the pelvic floor exercise group , three in the electrical stimulation group , and two in the vaginal cones group no longer considered themselves as having a problem . Conclusion : Training of the pelvic floor muscles is superior to electrical stimulation and vaginal cones in the treatment of genuine stress incontinence Objective To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied Treatment of urinary stress incontinence ( USI ) by intravaginal electrical stimulation ( IES ) and pelvic floor physiotherapy represents an alternative to other therapies . The purpose of this work was to evaluate the effectiveness of this treatment in patients with urinary incontinence . From January 1998 to May 2000 , 30 women ( mean age 54 years ) were studied . All patients had USI and 70 % urge incontinence ; average follow-up was 7 months . Selection criteria were based on clinical history , objective evaluation of perineal musculature by perineometry , and urodynamics . The treatment protocol consisted of three sessions of IES per week for 14 weeks using INNOVA equipment . Physiotherapy was initiated in the fifth week of IES . A significant decrease in the number of micturitions and urgency was observed after treatment ( P<0.01 ) . The pad test showed a reduction in urinary leakage from 13.9 to 5.9 g after treatment ( P<0.01 ) . Objective evaluation of perineal muscle strength showed a significant improvement in all patients after treatment ( P<0.01 ) . A positive correlation was observed between maximum flow rate ( Qmax ) and all three variables : urethral pressure profile at rest and on straining ( stop test ) , and abdominal leak-point pressure ( ALPP ) . A positive correlation was also observed between ALPP and the stop test . Over 100 different surgical and conservative treatments have been tried to manage USI . The majority of these procedures reveal that despite progress already made in this area , there is no ideal treatment . Satisfactory results can be achieved with this method , especially with patients who are reluctant to undergo surgery because of personal or clinical problems The purpose of this study was to compare the effect of three conservative interventions : pelvic floor muscle training , bladder training , or both , on urodynamic parameters in women with urinary incontinence . Two hundred four women with genuine stress incontinence ( GSI ) or detrusor instability with or without GSI ( DI + /- GSI ) participated in a two-site trial comparing pelvic floor muscle training , bladder training , or both . Patients were stratified based on severity of urinary incontinence , urodynamic diagnosis , and treatment site , then r and omized to a treatment group . All women underwent a comprehensive st and ardized evaluation including multi-channel urodynamics at the initial assessment and at the end of 12 weeks of therapy . Analysis of covariance was used to detect differences among treatment groups on urodynamic parameters . Post-treatment evaluations were available for 181 women . No differences were found among treatments on the following measurements : maximum urethral closure pressure , mean urethral closure pressure , maximum Kegel urethral closure pressure , mean Kegel urethral closure pressure , functional urethral length , pressure transmission ratios , straining urethral axis , first sensation to void , maximum cystometric capacity , and the MCC minus FSV . The effect of treatment did not differ by urodynamic diagnosis . Behavioral therapy had no effect on commonly measured urodynamic parameters . The mechanism by which clinical improvement occurs remains unknown . Neurourol . Urodynam . 18:427 - 436 , 1999 OBJECTIVE : To investigate morphological and functional changes after pelvic floor muscle training in women with pelvic organ prolapse . METHODS : This r and omized controlled trial was conducted at a university hospital and a physical therapy clinic . One hundred nine women with pelvic organ prolapse stages I , II , and III were r and omly allocated by a computer-generated r and om number system to pelvic floor muscle training ( n=59 ) or control ( n=50 ) . Both groups received lifestyle advice and learned to contract the pelvic floor muscles before and during increases in intraabdominal pressure . In addition the pelvic floor muscle training group did individual strength training with a physical therapist and daily home exercise for 6 months . Primary outcome measures were pelvic floor muscle ( pubovisceral muscle ) thickness , levator hiatus area , pubovisceral muscle length at rest and Valsalva , and resting position of bladder and rectum , measured by three-dimensional ultrasonography . RESULTS : Seventy-nine percent of women in the pelvic floor muscle training group adhered to at least 80 % of the training protocol . Compared with women in the control group , women in the pelvic floor muscle training group increased muscle thickness ( difference between groups : 1.9 mm , 95 % confidence interval [ CI ] 1.1–2.7 , P<.001 ) , decreased hiatal area ( 1.8 cm2 , 95 % CI 0.4–3.1 , P=.026 ) , shortened muscle length ( 6.1 mm , 95 % CI 1.5–10.7 , P=.007 ) , and elevated the position of the bladder ( 4.3 mm , 95 % CI 2.1–6.5 , P<.000 ) and rectum ( 6.7 mm , 95 % CI 2.2–11.8 , P=.007 ) . Additionally , they reduced the hiatal area and muscle length at maximum Valsalva indicating increased pelvic floor muscle stiffness . CONCLUSION : Supervised pelvic floor muscle training can increase muscle volume , close the levator hiatus , shorten muscle length , and elevate the resting position of the bladder and rectum . CLINICAL TRIAL REGISTRATION : www . clinical trials.gov , NCT00271297 . LEVEL OF EVIDENCE : The purpose of the study was to compare the effect of voluntary pelvic floor muscle ( PFM ) contraction and vaginal electrical stimulation on urethral pressure .  Twelve women with genuine stress incontinence , mean age 49.4 years ( range 33–66 ) participated in the study . The urethral and bladder pressures were recorded simultaneously through a double-lumen 8 Ch catheter . The patients first performed three voluntary PFM contractions . Then two electrical stimulators , Conmax and Medicon MS 105 , 50 Hz , were used in r and om order . A visual analog scale was used to measure pain and discomfort . Pain was reported to mean 6.8 , SEM 0.64 ( range 0.7–9.9 ) and mean 6.1 , SEM 0.81 ( range 0–9.1 ) with Conmax and Medicon MS 105 , respectively . The mean paired difference in favor of voluntary contraction with Conmax was −8.0 , SD 6.7,P=0.0067 , and with Medicon MS 105 it was −12.2 , SD 5.9,P=0.0022 . The results demonstrated that voluntary PFM contraction increased urethral pressure significantly more than did vaginal electrical stimulation BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . The aim of this study was to assess the effects of voluntary pelvic floor contraction and voluntary pelvic floor relaxation on the urethral closure pressure at rest . In 104 consecutive women , three urethral pressure profiles were performed : st and ard profile at rest , with voluntary pelvic floor contraction and with voluntary pelvic floor relaxation . A low-pressure urethra was defined as a maximum urethral closure pressure of ≤20 cmH2O . The age ranged between 24 and 82 years .  The maximum urethral closure pressure at rest was significantly augmented during pelvic floor contraction ( mean : 18 cmH2O ) . Compared with the first profile , it decreased significantly with pelvic floor relaxation ( mean decrement : 8 cmH2O ) . A low-pressure urethra was detected in 5 women during the first profile and in a further 11 during pelvic floor relaxation . Because of the significant influence of pelvic floor activity on the urethral closure pressure at rest , the scientific and clinical credibility of urethral pressure measurements remain question able AIMS To study the relation between maximum urethral closure pressure at rest and urethral hypermobility in female patients . PATIENTS AND METHODS We selected 255 patients aged 20 years and older , with a stable bladder on multichannel urodynamics , without known neurological pathology , and without a history of pelvic or anti-incontinence surgery . A resting urethral pressure profile and the degree of urethral hypermobility were registered . Two-tailed analyses of variance ( ANOVA ) with Fisher 's post-hoc tests were used to detect any statistically significant difference ( P < 0.05 ) in urethral closure pressure between groups with varying degrees of urethral hypermobility . RESULTS Mean age was 45.6 + /- 12.7 ( range 20 - 77 ) years .  Mean maximum urethral closure pressure for the entire group was 62.7 + /- 29 ( range 10 - 150 ) cm of water . A statistically significant inverse relationship was found between age and maximum urethral closure pressure ( r = 0.489 , P < 0.0001 ) when both analyzed as continuous variables , and with age categorized in 10-year increments ( P < 0.0001 ) . When comparing mean urethral closure pressure in each group examined for urethral hypermobility , a statistically significant difference was noted when grade s I , II , and III were compared to grade 0 hypermobility . No significant difference was observed when grade s I , II , and III 
    Output:
    
Conclusions There is no definitive evidence that PFMT increases resting MUCP as its mechanism of action in managing SUI .
There was evidence to suggest PFMT increases augmented MUCP .