外科ジャーナル

Efficacy of Electrogalvanic Stimulation in Treatment of Levator Ani Syndrome Revisited

Abstract

Mantilla N, Paris B, Abcarian H, Cintron J, Zavala A, and Singer M

Introduction: Electrogalvanic stimulation (EGS) has been established as a safe and effective treatment for the management of levator ani syndrome (LAS). There is a paucity of recent literature regarding this treatment modality. The purpose of this study is to review recent experience with EGS in the treatment of levator ani syndrome at a single center.

Methods: A retrospective review of 22 patients treated with EGS for LAS from 07/04 to 08/08 was done. The EGS protocol begins with 30 minute sessions. Voltage is adjusted based on patient tolerance (range 100-330 volts) and is delivered at a frequency of 100 pulses per sec (pps). Length of treatment is gradually increased with increasing patient tolerance, from 30 to 60 min. Each session starts with minimal voltage and is slowly increased to maximum tolerance, held for 15-20 minutes, then intensity is gradually reduced from the peak of 100-330 volts to a minimum of 10-100 volts. Most patients were treated three times weekly for two weeks (average, six treatments per patients). The mean number of sessions was 7.5 (range 2-15). The average of duration of each session was 29 minutes for the initial visit and 46 minutes for the concluding visit. The intensity was 70% at initial visit, and 88% by the last treatment (330 volts=100%).

Results: Twenty two patients were treated (72% males). The mean age was 56 years. The mean duration of symptoms was 60 months (range 3-240). 41 percent of patients had additional anorectal pathology. Over 60% of patients were taking muscle relaxants and/or analgesics. In this cohort, 59% of patients had previous treatment, including biofeedback (32%), botox injection (14%) and epidural injection (14%). Patient assessment of results at the last treatment session: complete relief or significant improvement in 8 patients (36%); moderate improvement in 2 (9%); slight improvement in 7 (32%); and no improvement or worsening of pain in 5 patients (23%). The mean follow up was 11 months (range 0.4-38). There were no complications associated with the EGS. Both multiple linear regression and logistic regression showed the same results. The outcome of patients with levator ani syndrome treated with EGS is related to the number of treatment sessions and history of previous treatments (of any sort).

Conclusions: EGS is an effective treatment option in a selected group of patients with LAS. It offers significant to moderate improvement in 45% of patients with essentially no risk. Due to its safety profile and moderate efficacy, it should continue to be considered as a treatment operation for levator ani syndrome.