***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: Background and Purpose Although surgery has been widely accepted as the treatment of choice for stress urinary incontinence ( SUI ) , there has recently been an increased interest in the conservative management of this condition . The aims of this study were to test the ability of a biofeedback-assisted pelvic-floor muscle exercise ( PFME ) program to affect symptoms of SUI in premenopausal women and to evaluate a training program that might lead to successful outcomes in a relatively limited number of sessions . Subjects Twenty-six women with SUI were treated with PFME with surface electromyography (sEMG)–assisted biofeedback .  All participants were of reproductive age and were treated individually for 12 sessions . Methods Results were evaluated with a 7-day voiding diary , a 1-hour pad test , pelvic-floor muscle strength measurements , sEMG amplitudes , a leakage index , and a quality -of-life question naire . These variables were compared before and after the intervention . Results The frequency of urine loss , the occurrence of nocturia , and the number of pads required decreased significantly after the intervention . Objective cure was found in 61.5 % of women . There was a significant improvement in the quality of life , in pelvic-floor muscle strength , and in the sEMG amplitudes of all contractions throughout the intervention . Discussion and Conclusion A relatively short-term intervention of PFME with sEMG-assisted biofeedback appeared to be helpful in relieving symptoms of SUI in premenopausal women and represents a reasonable conservative management option 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 Background Stress urinary incontinence ( SUI ) is a prevalent and costly condition which may be treated surgically or by physical therapy . The aim of this review was to systematic ally assess the literature and present the best available evidence for the efficacy and effectiveness of pelvic floor muscle training ( PFMT ) performed alone and together with adjunctive therapies ( eg biofeedback , electrical stimulation , vaginal cones ) for the treatment of female SUI . Methods All major electronic sources of relevant information were systematic ally search ed to identify peer- review ed English language abstract s or papers published between 1995 and 2005 . R and omised controlled trials ( RCTs ) and other study design s eg non-r and omised trials , cohort studies , case series , were considered for this review in order to source all the available evidence relevant to clinical practice . Studies of adult women with a urodynamic or clinical diagnosis of SUI were eligible for inclusion . Excluded were studies of women who were pregnant , immediately post-partum or with a diagnosis of mixed or urge incontinence . Studies with a PFMT protocol alone and in combination with adjunctive physical therapies were considered . Two independent review ers assessed the eligibility of each study , its level of evidence and the method ological quality . Due to the heterogeneity of study design s , the results are presented in narrative format . Results Twenty four studies , including 17 RCTs and seven non- RCTs , met the inclusion criteria . The method ological quality of the studies varied but lower quality scores did not necessarily indicate studies from lower levels of evidence . This review found consistent evidence from a number of high quality RCTs that PFMT alone and in combination with adjunctive therapies is effective treatment for  women  with  SUI  with rates of ' cure ' and ' cure/improvement ' up to 73 % and 97 % respectively . The contribution of adjunctive therapies is unclear and there is limited evidence about treatment outcomes in primary care setting s. Conclusion There is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further high quality studies are needed to evaluate the optimal treatment programs and training protocol s in subgroups of women and their effectiveness in clinical practice Biofeedback is a method of pelvic floor rehabilitation using a surface electrode inserted into the vagina and a catheter in the rectum . Forty women with genuine urinary stress incontinence were r and omized to compare the efficacy of physiotherapy and physiotherapy in combination with biofeedback . The effect of the treatment was determined by a st and ardized pad-weighing test . Long-term status was determined using a question naire after 2–3 years . Thirty-four women completed the treatment . The study showed a statistically significant better improvement in the biofeedback group . The long-term effect in the biofeedback group seemed better and the patients were more motivated for training afterwards 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 : The aim of this study was to compare the effectiveness of multimodal supervised physiotherapy programs with the absence of treatment among women with persistent postnatal stress urinary incontinence . METHODS : This was a single-blind r and omized controlled trial . Sixty-four women with stress urinary incontinence were r and omly assigned to 8 weeks of either multimodal pelvic floor rehabilitation ( n = 21 ) , multimodal pelvic floor rehabilitation with abdominal muscle training ( n = 23 ) , or control non – pelvic floor rehabilitation ( n = 20 ) . The primary outcome measure consisted of a modified 20-minute pad test . The secondary outcome measures included a Visual Analog Scale describing the perceived burden of incontinence , the Urogenital Distress Inventory , the Incontinence Impact Question naire , and pelvic floor muscle function measurements . RESULTS : Two patients dropped out , leaving 62 for analysis . At follow-up , more than 70 % of the women in the treatment groups ( 14/20 in the pelvic floor and 17/23 in the pelvic floor plus abdominal group ) were continent on pad testing compared with 0 % of women in the control group . Scores on the pad test , Visual Analog Scale , Urogenital Distress Inventory , and Incontinence Impact Question naire improved significantly in both treatment groups ( all P < .002 ) , whereas no changes were observed in the control group . Pelvic floor muscle function , however , did not improve significantly in either active group . CONCLUSION : Multimodal supervised pelvic floor physiotherapy is an effective treatment for persistent postnatal stress urinary incontinence . LEVEL OF EVIDENCE : Purpose : The aim of this study was to investigate and compare the short-term effects of a physical therapy program in patients with different intensities of urodynamic stress urinary incontinence ( USI ) . Subjects and Methods : 48 patients with USI were assigned to three groups according to the intensity of their incontinence : group I : 0–2 g ( n = 17 ) , group II ( mild intensity : > 2–10 g , n = 16 ) and group III ( moderate intensity : > 10 g , n = 15 ) as determined by the 1-hour pad test . A physical therapy program composed of Kegel exercises and interferential current was applied to all patients for duration of 5 weeks , with a total of 15 sessions . The number of pads used a day , frequency of voiding ( times/day ) , amount of urinary leakage according to the 1-hour pad test ( mg ) , severity of complaint ( as centimeters on visual analogue scale ) and pelvic floor muscle strength ( cm Hg ) were evaluated . Pre-treatment and post-treatment values of these data were compared in each group and among groups . Results : Analyses of the data indicated that the number of pads used a day , frequency of voiding and amount of urinary leakage decreased and pelvic floor muscle strength increased significantly in each group ( p < 0.05 ) . Cure in USI was found in 88 % of subjects in group I and 18 % of subjects in group II ( mild intensity ) . None of the patients in group III ( moderate intensity ) showed a cure effect . Conclusion : This physical therapy program was found to be more effective in mild and moderate intensities than severe USI Introduction and hypothesisPelvic floor muscle training ( PFMT ) is considered to be the first-line treatment for female stress urinary incontinence ( SUI ) . There are few studies that have tested the efficacy of unsupervised PFMT . The aim of this study was to compare the effectiveness of intensive supervised PFMT to unsupervised PFMT in the treatment of female SUI . Methods Sixty-two women with SUI were r and omized to either supervised or unsupervised PFMT after undergoing supervised training sessions . They were evaluated before and after the treatment with the Oxford grading system , pad test , quality of life question naire , subjective evaluation , and exercise compliance . Results After treatment , there were no differences between the two groups regarding PFM strength ( p = 0.20 ) , International Consultation on Incontinence Question naire-Short Form score ( p = 0.76 ) , pad test ( p = 0.78 ) , weekly exercise compliance ( p = 0.079 ) , and subjective evaluation of urinary loss ( p = 0.145 ) . Conclusions Both intensive supervised PFMT and unsupervised PFMT are effective to treat female SUI if training session is provided CONTEXT AND OBJECTIVE Urinary incontinence is a public health problem that affects more than 200 million people worldwide . Stress incontinence is the most prevalent type . Pelvic floor muscle exercises have been used for treating it , although there is no consensus regarding their application . The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision . DESIGN AND SETTING This was a r and omized , prospect i ve , controlled trial in the Urogynecology and Vaginal Surgery Sector , Universidade Federal de São Paulo . METHODS Forty-four women were r and omized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months , into two groups : one with and the other without physiotherapist supervision . They were evaluated before and after treatment using a quality -of-life question naire , pad test , micturition diary and subjective evaluation . Descriptive analysis was used 
    Output:
    
The most effective training protocol consists of SEPFM by digital palpation combined with biofeedback monitoring and vaginal cones , including 12 week training parameters , and ten repetitions per series in different positions compared with SEPFM alone or a lack of treatment