Short Term Results of Modified Ingelman-Sundberg Denervation Procedure for Female Mixed Urinary Incontinence

ABSTRACT

PURPOSE: We evaluated the clinical efficacy, safety and satisfaction of patients with modified Ingelman-Sundberg bladder denervation procedure for female mixed urinary incontinence. MATERIALS AND METHODS: Forty two women with mixed urinary incontinence were randomly assigned to the transobturator tape(TOT, n=20), or modified Ingelman-Sundberg bladder denervation procedure(MISD) with TOT (n=22) procedures, between August 2005 and July 2006. Preoperatively, the patients were evaluated with history taking, physical examination, urine analysis, urine culture, voiding diary, uroflowmetry, postvoid residual(PVR) and urodynamic evaluations. The procedures were carried out using a previously established method under spinal anesthesia for 36 patients and under general anesthesia for 6 patients. The postoperative evaluation included a questionnaire, uroflowmetry and PVR. The mean follow-up period was 8.2 months. RESULTS: 20 underwent TOT procedure alone and 22 underwent TOT procedure with MISD. Two groups were similar in their preoperative characteristics. The mean operation time was longer in the TOT procedure with MISD group compared to TOT procedure alone (36 min vs 26 min). There was significant difference between the 2 groups in terms of the success rate(cure+improvement, 30% vs 82%, p=0.03) cure(20% vs 50%), improvement(10% vs 32%), persistent(70% vs 18%) for TOT group and TOT with MISD group, respectively. In addition, the patient satisfaction rate was significantly different between TOT and TOT with MISD group(> or = Satisfied, 20% vs 64%, p=0.04). The main complication was voiding difficulty, including retention, was 10%(n=2) in the TOT group, versus 18%(n=4) in the TOT with MISD group, but this was improved by conservative treatment. CONCLUSION: Despite the short term follow-up period, the modified Ingelman- Sundberg bladder denervation procedure is simple, effective and less invasive for the treatment of mixed urinary incontinence, which is able to perform with TOT procedure in terms of the high success and the low complication rates.