Changes in Urodynamic Measurements after Successful Anal Electrostimulation in Female Urinary Incontinence

Abstract

Fifty-five of 71 women with stress, motor urge and mixed stress and motor urge urinary incontinence were treated successfully with a new integrated electrostimulation device (Incontan) used anally. Changes in urodynamic measurements were evaluated when the patients themselves reported cure or significant improvement. The duration of the treatment was 9 to 20 h/day for at least 2 months (mean 9 months). According to the patients' subjective evaluation, 71% were cured of their incontinence and 29% were markedly improved. In motor urge and mixed incontinence a significant increase in bladder volume at first sensation and at maximum cystometric capacity was found, and 45% of these patients had a normal, stable bladder after treatment. A significant increase in functional urethral length was observed in patients who had had stress incontinence, but the measured increase in maximum urethral pressure was not significant. Of the 16 patients with stress and mixed incontinence who reported cure, 15 had a positive urethral closure pressure during coughing after treatment. Urodynamic analysis confirmed the positive clinical effect observed after electrostimulation therapy. It is recommended as primary therapy in stress, motor urge and mixed stress and motor urge incontinence in women.

Urodynamic changes induced by the intravaginal electrode during pelvic floor electrical stimulation

“…Changes on the FPL and MUCP were also demonstrated, but no correlation to the achieved clinical results could be established [Eriksen and Mjolnerod, 1987]. More recently, it was demonstrated that 40% of the patients that persisted with the urinary incontinence had a statistically signi¢cant increase of the FPL and MUCP [Chamorro et al, 1997].…”

“…The bene¢ts of stimulation therapy were seen in terms of changes to the urethral pressure pro¢le and cystometry, as well as the modi¢cations of the bladder and continence mechanism [Harrison and Paterson, 1970;Glen, 1974]. However, several authors reported no correlation between urodynamic ¢ndings and clinical results [Sotiropoulos et al, 1976;Plevnik and Janez, 1979;Eriksen and Mjolnerod, 1987;Chamorro et al, 1997].…”

“…After some stimulation sessions, many studies showed cystometric modi¢cations, mainly increase of maximum cystometric capacity and retarding on the ¢rst desire to void [Eriksen and Mjolnerod, 1987;Agudelo et al, 1996]. In patients with detrusor instability, the disappearance of the bladder involuntary contractions and normalization of the ¢ll-ing sensations were observed in 51% of the patients after a treatment period .…”

Laparoscopic implantation of temporary electrodes for bladder stimulation in dogs

“…At the present time, the main field for therapeutic electrostimulatory influence on urinary bladder functions, is to treat incontinence [Eriksen and Mjolnerod, 1987;Fall and Lindstrom, 1991;Kaplan et al, 1989;Lindstrom et al, 19831. Temporary placement of electrostimulatory devices into the vagina, the anal sphincter, or transurethrally, may result in an increase of bladder capacity or improvement of sphincters function.…”

Technique of Percutaneous Electrode Implantation for Electrical Pelvic Floor Stimulation

“…In general the following four types of electrodes have been utilized in pelvic floor stimulation: (1) an anal and/or vag inal device [1,4,7,8]; (2) surface electrode [9]; (3) needle electrode [1], and (4) implanted cuff or wire electrode [10][11][12], In patients with detrusor incontinence, this type of treatment results in bladder inhibition, which can be observed as an increase in bladder volume or abolition of abortive detrusor contraction and is mediated by spinal reflex pathways [5,6,[13][14][15][16].…”