***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: 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 Fifty consecutive female patients with genuine urinary stress incontinence were r and omized either to surgery or to a pelvic floor training program . The operative procedure was chosen according to the type of bladder suspension defect on micturition cystourethrography . The training program was given 5 times in weekly lessons and the patients were guided by trained physiotherapists . Surgery was superior to the pelvic floor training program both subjectively and objective ly . However , a significant improvement was found following the training program . Forty-two percent were satisfied with the outcome of the training and did not want operation . We find physiotherapist-guided pelvic floor exercise a realistic alternative to surgery in patients with mild degrees of stress incontinence . Also patients with residual symptoms after surgery are c and i date s for pelvic floor training CONTEXT Urinary incontinence is a common condition caused by many factors with several treatment options . OBJECTIVE To compare the effectiveness of biofeedback-assisted behavioral treatment with drug treatment and a placebo control condition for the treatment of urge and mixed urinary incontinence in older community-dwelling women . DESIGN R and omized placebo-controlled trial conducted from 1989 to 1995 . SETTING University-based outpatient geriatric medicine clinic . PATIENTS A volunteer sample of 197 women aged 55 to 92 years with urge urinary incontinence or mixed incontinence with urge as the predominant pattern . Subjects had to have urodynamic evidence of bladder dysfunction , be ambulatory , and not have dementia . INTERVENTION Subjects were r and omized to 4 sessions ( 8 weeks ) of biofeedback-assisted behavioral treatment , drug treatment ( with oxybutynin chloride , possible range of doses , 2.5 mg daily to 5.0 mg 3 times daily ) , or a placebo control condition . MAIN OUTCOME MEASURES Reduction in the frequency of incontinent episodes as determined by bladder diaries , and patients ' perceptions of improvement and their comfort and satisfaction with treatment . RESULTS For all 3 treatment groups , reduction of incontinence was most pronounced early in treatment and progressed more gradually thereafter . Behavioral treatment , which yielded a mean 80.7 % reduction of incontinence episodes , was significantly more effective than drug treatment ( mean 68.5 % reduction ; P=.04 ) and both were more effective than the placebo control condition ( mean 39.4 % reduction ; P<.001 and P=.009 , respectively ) . Patient-perceived improvement was greatest for behavioral treatment ( 74.1 % " much better " vs 50.9 % and 26.9 % for drug treatment and placebo , respectively ) . Only 14.0 % of patients receiving behavioral treatment wanted to change to another treatment vs 75.5 % in each of the other groups . CONCLUSION Behavioral treatment is a safe and effective conservative intervention that should be made more readily available to patients as a first-line treatment for urge and mixed incontinence PURPOSE We determine the efficacy and user acceptability of the urethral occlusive device ( FemAssist ) for incontinence for 1 month and identify factors that may predict successful use of the device . MATERIAL S AND METHODS Baseline and posttreatment outcome measures included a 1-hour pad test , frequency volume chart ( leakage , voiding and number of pads per 24 hour ) , visual analog scale for incontinence impact and quality of life ( Urogenital Distress Inventory ) . The last 36 consecutive women also completed a linear analog scale about attitudes toward touching the genitalia . RESULTS The device was offered to 100 consecutive incontinent women of whom 3 did not enroll in the study and 57 ( 57 % ) completed the 1-month trial . Age , incontinence type or severity and attitudes about touching the genitalia were not significantly different between dropouts and participants . Only 13 % of recruits were disinclined to place the device on the urethra . Significant reduction of incontinence was observed for all outcome measures with the device in situ . Pad testing revealed that 47 % of the patients became continent and 33 % had more than 50 % benefit , while 9 % had worse leakage . Those with severe baseline leakage were equally likely to respond as those with mild or moderate pad test loss . Women with stress , urge or mixed incontinence appeared to respond equally well . CONCLUSIONS The urethral occlusive device provides a further nonsurgical treatment option which is useful for a range of incontinence types In the United Kingdom regular urinary incontinence affects over 2000000 women and costs the NHS about pounds sterling70 million a year on aids and appliances . The assessment and treatment services lack a coherent plan for its recognition and treatment , and where and from whom care is best received is debated.1 Few of the current management strategies  ( pelvic exercises , appliances , drugs , and surgery )  have been the subject of well design ed r and omised controlled trials in primary care , and few studies have reported long term results .2 3 4 Thus lack of evidence combined with poorly trained primary care physicians and nurses has meant that fewer than one in three patients are recognised and fewer still are appropriately managed.1 In 1991 we reported the results Sixty-nine female patients with symptoms of stress urinary incontinence were r and omized to treatment with either interferential therapy or weighted vaginal cones .  Fifty-four patients completed treatment  ( interferential therapy , 30 patients ; weighted vaginal cones , 24 patients ) . Patients were assessed by subjective response , pad testing , continence charts , and the maximum weight of cone that could be held actively and passively . Forty-seven patients were reassessed at 6 months ( 19 cones ; 28 interferential ) , five patients ( 9.26 % ) required surgery , and two patients ( 3.7 % ) could not be reassessed . Subjective response to treatment was good , with 80 % to 90 % of patients cured or improved after treatment . After 6 months , 41.67 % in the cone group and 40 % in the interferential group were subjectively cured , with improvement in 50 % and 30 % , respectively . Of those patients initially referred for treatment , greater than 30 % in each group were cured of symptoms . There was an objective improvement in both groups . In the cone group 50 % had improved after treatment and greater than 60 % had improved at 6 months as assessed by pad testing , while in the interferential group 76 % had improved after treatment and 73 % had improved at 6 months . There was no significant difference in improvement between the two groups in any of the methods of assessment . However , the cones require less supervision by trained staff and can be used at home by the patient . Their use results in a savings in time for the physiotherapy department . The use of the cones is recommended as a cost-effective method of treatment that can be added to the present therapy options available to the physiotherapist The aim of this study was to assess the usefulness of pelvic floor exercises in the treatment of urinary incontinence in women and to analyse the factors which determine a successful outcome . The study involved 66 women who had reported ' genuine stress incontinence ' to their general practitioner . They were assigned at r and om to the treatment or control group . The treatment group received instructions in pelvic floor exercises from a general practitioner . The control group received no therapy . At the start of the trial the severity of the patients ' incontinence was assessed objective ly . This assessment was repeated after three months and patients were also asked for their own perception of whether their incontinence had improved . After the three months ' evaluation the patients in the control group were also given instructions in pelvic floor exercises . After another three months they were assessed in the same way . About 60 % of the patients in the treatment group were dry or mildly incontinent after three months compared with only one patient in the control group ; the mean weekly frequency of incontinence episodes fell from 17 to five in the treatment group but remained virtually unchanged in the control group ; and about 85 % of the women in the treatment group felt that their incontinence had improved or was cured compared with no one in the control group . These results were later corroborated by those for the control group . The most important factor in the success of the treatment was the patients ' motivation , as demonstrated by their adherence to the daily exercises . ( ABSTRACT TRUNCATED AT 250 WORDS 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 measure the unmet need of patients with regular urinary incontinence ( incontinence twice or more a month ) treatable by a nurse . DESIGN --Self completed postal question naire and r and omised controlled trial of assessment and intervention by a nurse . SETTING --One urban and one rural general practice in Somerset . SUBJECTS--7300 adults r and omly selected from 10,300 aged 35 and over on the combined practice lists . 515 women and 185 men with regular incontinence were offered assessment and treatment  , of whom 134 women and 49 men had no intervention for three months ( historical controls ) . They then joined the assessment and treatment programme . INTERVENTION -- Four sessions of pelvic floor exercises and bladder retraining supervised by non-specialist nurse who had taken a three week course on assessing and treating uncomplicated incontinence . MAIN OUTCOME MEASURES --Number of patients desiring treatment ; self reported cure , improvement , or deterioration in continence after three months . RESULTS --The question naire achieved a 79 % response . Vali date d responses showed a prevalence of 4.4 % in men and 16.4 % in women aged 35 - 64 . 315 ( 45 % ) of the 700 patients offered assessment refused it and seven had moved away or died , 64 men and 41 women were referred to their general practitioner . 197 of 292 treated women ( 68 % ) reported cure or improvement compared with seven ( 5 % ) of controls . 22 of the 86 men desiring treatment were suitable for intervention by the nurse . Seventeen were cured or improved compared with none of the men in the control group . CONCLUSIONS --About half the people with regular urinary incontinence took up the offer of treatment ( 9.2 % of women and 3.4 % of men in the study population ) . This condition can be effectively managed by a nurse with limited training Regular urinary incontinence affects one in six adult women . However , for the majority , good continence services are difficult to access and few primary care-based assessment and treatment facilities are available . A large r and omised trial of assessment and treatment in primary care using a trained nurse was conducted in Somerset in 1990 . This report summarises the methods and results of the initial study and reports the four-year follow-up results . The results show that 70 per cent of women will gain 
    Output:
    
Pelvic floor muscle training was better than no treatment or  placebo treatments for women with stress or mixed incontinence . '
Intensive ' appeared to be better than ' st and ard ' pelvic floor muscle training .
There is insufficient evidence to determine if pelvic floor muscle training is better or worse than other treatments .
Evidence of the effect of adding other adjunctive treatments to PFMT ( e.g. vaginal cones , intravaginal resistance ) is equally limited .
The effectiveness of biofeedback assisted PFMT is not clear , but on the basis of the evidence available there did not appear to be any benefit over PFMT alone at post treatment assessment .
Long-term outcomes of pelvic floor muscle training are unclear .
Side effects of pelvic floor muscle training were uncommon and reversible .
REVIEW ER 'S CONCLUSIONS Pelvic floor muscle training appeared to be an effective treatment for adult women with stress or mixed incontinence .
Pelvic floor muscle training was better than no treatment or placebo treatments .
The limitations of the evidence available mean that is difficult to judge if pelvic floor muscle training was better or worse than other treatments .
Most trials to date have studied the effect of treatment in younger , premenopausal women .