To the Editor,

We read with great interest the recent article comparing the effectiveness of pelvic floor muscle training (PFMT) with that of vitamin D replacement in postpartum women with stress urinary incontinence (SUI) [1].

In this randomized trial, 57 women with vitamin D deficiency and SUI were included and divided into vitamin D replacement (n=29) and PFMT (n=28) groups. Starting from the 8th week postpartum, 1,200 IU of vitamin D was given daily to the replacement group for 12 weeks, whereas the PFMT group performed Kegel exercises. The benefit of the patients from the treatments was also evaluated and compared using the Oxford scale and International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) tools. As a result, the changes after treatment in the Oxford and ICIQ-FLUTS scores of the vitamin D group were found to be significantly higher than those of the PFMT group. In conclusion, Aydogmus et al. concluded that the effectiveness of vitamin D replacement in treating SUI postpartum was significantly greater than PFMT alone.

Indeed, this study will lead to further studies. However, it is crucial to mention some of the limitations of this work. First, to achieve more objective results, a stress test and pad test should be performed in the baseline and control evaluation of SUI. Second, the efficacy of supervised intensive PFMT in the treatment of postpartum SUI was demonstrated by a recent Cochrane review [2] and at least 3 months of intensive and supervised PFMT is strongly recommended as a first-line therapy by the European Urology Guidelines [3].

Another point is that more than half of the postpartum patients in this study were reported to have delivered by cesarean section. As vaginal delivery has been shown to increase the risk of SUI 2 times more than cesarean section delivery [4], grouping patients into those who had undergone vaginal birth and those who had had a cesarean section delivery would give more accurate results. Finally, including placebo and vitamin D + PFMT groups in such a study will allow researchers to make precise interpretations.