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Correspondence to Author: Diego F. Almeida, MD¹; Mateo R. Guzmán, MD²; Andrés I. Vargas, MD³; Laura N. Beltrán, MD⁴; Ricardo E. Montero, PhD⁵. 

¹ Department of Physical Medicine and Rehabilitation, Federal University of Rio Grande, Brazil ² Department of Urology and Men’s Health, Universidad Nacional de Colombia, Colombia ³ Department of Pelvic Floor Rehabilitation, Hospital Clínico de Santiago, Chile ⁴ Department of Gynecology and Functional Rehabilitation, Universidad de Buenos Aires, Argentina ⁵ Department of Biomedical Engineering and Electrophysiology, São Paulo Institute of Medical Technology, Brazil

DOI: 10.52338/jocogr.2026.5815

Abstract:

Background: Pelvic floor dysfunction, stress urinary incontinence (SUI), urge urinary symptoms, erectile dysfunction (ED), chronic pelvic instability, and weakened core musculature are highly prevalent conditions associated with aging, childbirth, obesity, sedentary lifestyle, and neuromuscular deconditioning. Conventional treatment approaches—including pelvic floor physiotherapy, biofeedback, electrical stimulation, pharmacotherapy, and surgery—may be limited by adherence, invasiveness, discomfort, or inconsistent long-term response. High-intensity electromagnetic stimulation has emerged as a non-invasive therapeutic modality capable of inducing supramaximal muscle contractions and neuromuscular activation without direct skin contact.
Objective: This multicenter prospective study evaluated the safety, tolerability, clinical response, sonographic changes, histopathological findings, and molecular remodeling patterns associated with the Heager GmbH Alfonse electromagnetic therapy system, a multimodal platform incorporating three independent electromagnetic field generators intended to target pelvic floor musculature, cavernous/perineal musculature, and abdominal/core musculature simultaneously or independently.
Methods: A prospective multicenter clinical cohort study was conducted across rehabilitation, urogynecology, and men’s health centers in South America between 2022 and 2025. One hundred adult participants with stress urinary incontinence, mixed urinary symptoms, erectile dysfunction, postpartum pelvic floor weakness, chronic low back pain associated with core weakness, or generalized pelvic floor dysfunction underwent a structured treatment protocol using the Heager GmbH Alfonse electromagnetic therapy system. The platform incorporates three independent generators with nominal field capacities of 3 Tesla, 2.5 Tesla, and 1.5 Tesla directed toward pelvic floor, abdominal/core, and cavernous/perineal muscle regions respectively.
Clinical outcomes included International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), International Index of Erectile Function-5 (IIEF-5), pelvic floor strength grading, pain scores, quality-of-life assessment, and patient-reported global improvement. Imaging and biological analyses included transperineal ultrasonography, muscle thickness evaluation, histopathological staining, immunohistochemical markers including α-smooth muscle actin (α-SMA) and vascular endothelial growth factor (VEGF), and exploratory tissue remodeling assessment.
Results: Substantial clinical improvement was observed across multiple outcome domains. Mean ICIQ-SF scores improved significantly in patients with urinary symptoms, while male participants with erectile dysfunction demonstrated clinically meaningful increases in IIEF-5 scores. Sonographic assessment demonstrated increased pelvic floor muscle density and improved structural organization after treatment. Histopathological evaluation demonstrated improved muscle fiber alignment, reduced interstitial disorganization, increased α-SMA expression, and enhanced VEGF-associated vascular signaling. Participants also reported improvement in core stability, pelvic support sensation, and chronic lower back discomfort. No serious adverse events were observed. Mild transient muscle soreness was the most common self-limited adverse effect.
Conclusion: The Heager GmbH Alfonse multimodal electromagnetic therapy system demonstrated encouraging shortterm clinical, sonographic, and biological outcomes in pelvic floor rehabilitation, urinary symptom management, erectile dysfunction support, and core muscle strengthening. These findings support further randomized sham-controlled studies with standardized neuromuscular assessment, objective electrophysiologic analysis, and longer-term follow-up.

Citation:

Dr. Smith Clinton MD, Multimodal High-Intensity Electromagnetic Therapy Using The Heager Gmbh Alfonse System For Pelvic Floor Dysfunction, Stress Urinary Incontinence, Erectile Dysfunction, And Core Muscle Rehabilitation: A Prospective Multicenter Clinical, Sonographic, Histopathological, And Molecular Study. Journal of Clinical Obstetrics and Gynecology Research 2026.