***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: 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 AIMS To evaluate the clinical and cost-effectiveness of electric stimulation plus st and ard pelvic floor muscle training compared to st and ard pelvic floor muscle training alone in women with urinary incontinence and sexual dysfunction . METHODS Single centre two arm parallel group r and omised controlled trial conducted in a Teaching hospital in Engl and . Participants were women presenting with urinary incontinence and sexual dysfunction . The interventions compared were electric stimulation versus st and ard pelvic floor muscle training . OUTCOME MEASURES included Prolapse and Incontinence Sexual function Question naire ( PISQ ) physical function dimension at post-treatment ( primary ) ; other dimensions of PISQ , SF-36 ; EQ-5D , EPAQ , re source use , adverse events and cost-effectiveness ( secondary outcomes ) . RESULTS 114 women were r and omised ( Intervention n=57 ; Control group n=57 ) . 64/114 ( 56 % ) . PARTICIPANTS had valid primary outcome data at follow-up ( Intervention 30 ; Control 34 ) . The mean PISQ-PF dimension scores at follow-up were 33.1 ( SD 5.5 ) and 32.3 ( SD 5.2 ) for the Intervention and Control groups respectively ; with the Control group having a higher ( better ) score . After adjusting for baseline score , BMI , menopausal status , time from r and omisation and baseline oxford scale score the mean difference was -1.0 ( 95 % CI : -4.0 to 1.9 ; P=0.474 ) . There was no differences between the groups in any of the secondary outcomes at follow-up . Within this study , the use of electrical stimulation was cost-effective with very small incremental costs and quality adjusted life years ( QALYs ) . CONCLUSIONS In women presenting with urinary incontinence in conjunction with sexual dysfunction , physiotherapy is beneficial to improve overall sexual function . However no specific form of physiotherapy is beneficial over another . Trial registration IS RCT N09586238 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 OBJECTIVE To evaluate the effects of surface electrical stimulation ( SES ) and to compare them with the effects of the intravaginal electrical stimulation ( IVES ) in women with stress urinary incontinence ( SUI ) . STUDY DESIGN This r and omized controlled study included 48 women aged over 50 years , who complained of SUI evaluated according to two structured questions of King 's Health Question naire ( KHQ ) and who had not previously undergone physical therapy for SUI . The calculation of the sample size estimated a sample of 45 volunteers with a significance level of 5 % and statistical power of 90 % . The women were r and omized to : Surface Electrical Stimulation Group ( SESG ) ( n=15 ) , Intravaginal Electrical Stimulation Group ( IVESG ) ( n=15 ) and Control Group ( CG ) ( n=15 ) . Subjects in the intervention groups were treated with the same parameters of electrical stimulation for 12 sessions . The SESG had four silicone electrodes fixed in the suprapubic and ischial tuberosity regions . The IVES group used an intravaginal electrode . The CG did not receive any treatment during the corresponding time . They were evaluated before and after treatment by a physical therapist who was blind to group allocation . The primary outcomes were urinary leakage , pressure and strength of pelvic floor muscle ( PFM ) contraction . The secondary outcome was quality of life ( QOL ) evaluated by KHQ . Forty-five women completed the study and were included in the analysis . Statistical analysis was performed using the Wilcoxon test for intragroup analysis and Kruskal-Wallis and Mann-Whitney tests for intergroup analysis ( p<0.05 ) . RESULTS There was significant improvement in urinary loss and pressure of contraction in the SESG and IVESG . PFM strength increased only in the IVESG . Intergroup analysis found differences after the treatment in : urinary leakage between the SESG and CG ( p<0.001 ) and the IVESG and CG ( p<0.001 ) . Regarding QOL , there was significant reduction in the incontinence impact , limitations of daily activities , physical limitation , emotion , sleep and disposition and severity domains in the SESG ( all p<0.02 ) and IVESG ( all p<0.04 ) after the treatments . CONCLUSION SES and IVES are important treatments to improve the SUI . Both improved the QOL , urinary leakage , and strength and pressure of PFM contraction PURPOSE To compare the effectiveness of pelvic floor exercises , electrical stimulation , vaginal cones , and no active treatment in women with urodynamic stress urinary incontinence . PATIENTS AND METHODS One hundred eighteen subjects were r and omly selected to recieve pelvic floor exercises ( n=31 ) , ES ( n=30 ) , vaginal cones ( n=27 ) , or no treatment ( untreated control ) ( n=30 ) . Women were evaluated before and after completion of six months of treatment by the pad test , quality of life question naire ( I-QOL ) , urodynamic test , voiding diary , and subjective response . RESULTS In the objective evaluation , we observed a statistically significant reduction in the pad test ( p=0.003 ) , in the number of stress urinary episodes ( p<0.001 ) , and a significant improvement in the quality of life ( p<0.001 ) in subjects who used pelvic floor exercises , electrical stimulation , and vaginal cones compared to the control group . No significant difference was found between groups in the urodynamic parameters . In the subjective evaluation , 58 % , 55 % , and 54 % of women who had used pelvic floor exercises , electrical stimulation , and vaginal cones , respectively , reported being satisfied after treatment . In the control group , only 21 % patients were satisfied with the treatment . CONCLUSION Based on this study , pelvic floor exercises , electrical stimulation , and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence 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 Several different methods of enhancing pelvic floor functions have been developed and modified . The aim of this study was to compare the efficacy of a new vaginal cone with conventional FES-Biofeedback therapy for female urinary incontinence , with respect to pelvic floor rehabilitation . One hundred and twenty patients , who required a non-surgical treatment for urinary incontinence , were divided r and omly into two groups ; ( 1 ) the Functional Electrical Stimulation (FES)- Biofeedback group ( or BFB group ) and ( 2 ) the new vaginal cone group ( or cone group ) . For a period of six weeks , two training sessions each week were carried out on the BFB group . The new 150-gram dumbbell-shaped vaginal cone , made of fine ceramic material , was developed domestically . A therapist instructed patients in the cone group upon its use for pelvic floor exercise , and directed the exercise to be repeated at home daily ; these patients had follow-up visits every week . Objective improvements were obvious in both groups . 88.3 % and 91.6 % of the cone and BFB groups showed an improvement after treatment , respectively . There was no significant difference in the improvement or dissatisfaction scores of the two groups . In conclusion , no significant differences in the therapeutic effects were observed between the FES- Biofeedback  and the new vaginal cone groups . Considering improvements in the quality of life and objective symptoms , the therapeutic effects of the two techniques showed no significant differences . The new vaginal cone is relatively easy to use at home and aids in pelvic floor muscle exercises . Consequently , the new vaginal cone could be used as an alternative non-surgical treatment modality in female stress urinary incontinence Rehabilitative therapy of the perineum ( FKT , SEF and biofeedback ) represents an efficient method in the treatment of urinary stress incontinence without resorting to a complete uro-genital prolapse , as in patients with urethral instability and /or incontinence . One hundred twenty-one women , 55 with urinary stress incontinence ( USI ) , 20 with urge incontinence ( UI ) and 46 suffering from both types of incontinence , underwent rehabilitative therapy . On each patients the following tests were carried out : an internal test , a urodynamic test ( uroflowmeter , PPU , cystomanometry and pessure/flow study ) , a meter UEC , situated at the bladder neck , anterior and posterior urethra , both clinostatic and orthostatic , urine test with urinoculture and a pap-test . The aim of this study is that of establishing if it is possible 
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The effect estimate was 660/1000 women cured/improved with ES compared to 382/1000 with no active treatment ( 95 % CI 538 to 805 women ) ; and for sham treatment , 402/1000 women cured/improved with ES compared to 198/1000 with sham treatment ( 95 % CI 202 to 805 women).Low- quality evidence suggests that there may be no difference in cure or improvement for ES versus PFMT ( RR 0.85 , 95 % CI 0.70 to 1.03 ) , PFMT plus ES versus PFMT alone ( RR 1.10 , 95 % CI 0.95 to 1.28 ) or ES versus vaginal cones ( RR 1.09 , 95 % CI 0.97 to 1.21).Electrical stimulation probably improves incontinence-specific QoL compared to no treatment ( moderate quality evidence ) but there may be little or no difference between electrical stimulation and PFMT ( low quality evidence ) .
It is uncertain whether adding electrical stimulation to PFMT makes any difference in terms of quality of life , compared with PFMT alone ( very low quality evidence ) .
There may be little or no difference between electrical stimulation and vaginal cones in improving incontinence-specific QoL ( low quality evidence ) .
AUTHORS ' CONCLUSIONS The current evidence base indicated that electrical stimulation is probably more effective than no active or sham treatment , but it is not possible to say whether ES is similar to PFMT or other active treatments in effectiveness or not .
Without sufficiently powered trials measuring clinical ly important outcomes , such as subjective assessment of urinary incontinence , we can not draw robust conclusions about the overall effectiveness or cost-effectiveness of electrical stimulation for stress urinary incontinence in women