• Jorge Milhem Haddad, Ricardo Muniz Ribeiro, Wanderley Marques Bernardo, Maurício Simões Abrão, and Edmund Chada Baracat.
• Divisão de Clínica Ginecológica, Ginecologia Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. jorge_milhem@uol.com.br
• Clinics (Sao Paulo). 2011 Jan 1; 66 (5): 785791785-91.

ObjectiveTo evaluate vaginal cone therapy in two phases, passive and active, in women with stress urinary incontinence.MethodsA prospective study was conducted at the Department of Obstetrics and Gynecology, São Paulo University, Brazil. Twenty-four women with a clinical and urodynamic diagnosis of stress urinary incontinence were treated with vaginal cones in a passive phase (without voluntary contractions of the pelvic floor) and an active phase (with voluntary contractions), each of which lasted three months. Clinical complaints, a functional evaluation of the pelvic floor, a pad test, and bladder neck mobility were analyzed before and after each phase.ResultsTwenty-one patients completed the treatment. The reduction in absolute risk with the pad test was 0.38 (p<0.034) at the end of the passive phase and 0.67 (p<0.0001) at the end of the active phase. The reduction in absolute risk with the pelvic floor evaluation was 0.62 (p<0.0001) at the end of the passive phase and 0.77 (p<0.0001) at the end of the active phase. The reduction in absolute risk of bladder neck mobility was 0.38 (p<0.0089) at the end of the passive phase and 0.52 (p<0.0005) at the end of the active phase. Complete reversal of symptomatology was observed in 12 (57.1%) patients, and satisfaction was expressed by 19 (90.4%).ConclusionUsing vaginal cones in the passive phase, as other researchers did, was effective. Inclusion of the active phase led to additional improvement in all of the study parameters evaluated in women with stress urinary incontinence. Randomized studies are needed, however, to confirm these results.

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