Stress Urinary Incontinence Treatment With Microablative Radiofrequency, Pelvic Floor Muscle Training or Combination of Both Techniques in Climacteric Women: Randomized Controlled Trial 6‐Month Follow‐Up

ABSTRACT Introduction Fractional microablative radiofrequency (FMRF) has been used as an alternative to conservative treatments such as pelvic floor muscle training (PFMT). However, evidence supporting its effectiveness compared to or alongside these treatments is lacking. Objective To compare the effects of FMRF, PFMT, and their combination (PFMT + FMRF) on urinary symptoms and pelvic floor function in climacteric incontinent women over a 6‐month follow‐up. Methods This randomized, prospective, and controlled clinical trial, blinded to the investigator, included women aged 45–65 years with stress urinary incontinence, divided into three treatment groups: PFMT (12 weekly sessions), FMRF (3 monthly applications), and PFMT + RF. Urinary symptoms were assessed using the International Consultation on Incontinence Questionnaire Urinary Incontinence‐Short Form (ICIQ UI‐SF) and a 1‐h pad test. Pelvic floor function was evaluated using PERFECT and perineometry, along with treatment satisfaction. ANOVA was used to compare the results. Results The study included 117 women (39 in each group), with similar clinical and sociodemographic characteristics. SUI assessed by the ICIQ‐SF UI showed significant improvement in all groups posttreatment, maintained at follow‐up ( p < 0.001), with greater variation in the PFMT + RF group ( p = 0.002). The 1‐h pad test also improved in all groups, with effects lasting 6 months. Muscle function assessment showed similar Power improvement across all groups ( p < 0.001). Endurance improved posttreatment in the PFMT group, with a slight decline at 6 months ( p = 0.027), while the FMRF + PFMT group maintained their improvement ( p < 0.001). Repetition improved in the PFMT and RF + PFMT groups ( p < 0.001; p = 0.001). Fast contractions increased in all groups, with significant group x time interaction ( p = 0.002). Only the PFMT group showed improvement in Perineometry. At 6 months, 22.61% were very satisfied, 46.42% were satisfied, 10.71% reported being cured, and 69.04% reported symptom improvement. Conclusion The combination of techniques (RF + PFMT) showed superior results for treating UI in climacteric women over 6 months, promoting improvement in urinary symptoms and pelvic floor function compared to isolated treatments. Trial Registration: The trial is registered as REBEC ( Registro Brasileiro de Ensaios Clínicos ; Brazilian Registry of Clinical Trials) under number RBR‐9v3q33.