ACUTE AND LONG-TERM OUTCOMES OF RADIO FREQUENCY BLADDER NECK SUSPENSION

Abstract

A new treatment modality for women with stress urinary incontinence secondary to urethral hypermobility is radio frequency bladder neck suspension. Radio frequency energy is a form of electromagnetic energy that is reliable and highly controllable. This thermal therapy can produce well-defined areas of tissue heating. The technology has been used extensively in dermatological and orthopedic surgery for tissue shrinkage and ablation. Radio frequency thermal therapy is now being applied to the endopelvic fascia at the bladder neck and urethra for treating hypermobility in patients with stress urinary incontinence. The purported mechanism is shrinkage of the collagenated tissue that supports the bladder neck and proximal urethra. We report our acute and long-term experience with laparoscopic radio frequency bladder neck suspension for stress urinary incontinence. Enrolled in this prospective multicenter trial were 94 women with a mean age of 48.4 +/- 7.6 years who had urethral hypermobility with an average cotton swab angle change of 41 degrees and Valsalva leak point pressures greater than 90 cm. water at 250 ml. bladder capacity. Detrusor instability was excluded by cystometry. In all cases precisely controlled radio frequency energy was applied to the endopelvic fascia to heat and shrink the tissue. The primary end points were physician assessment of continence, patient reported pad use and the number of patient reported episodes of urinary incontinence daily 1, 3, 6 and 12 months after surgery. Average operative time was less than 60 minutes and 98% of the patients were discharged home from the recovery room. Treatment surface area decreased an average of 17% in length and 21% in width. Preoperatively 78% of patients had an average of 1 or more episodes of urinary incontinence daily. At 1, 3, 6 and 12 months there was an average of 1 or fewer episodes of urinary incontinence daily in 84.7%, 85.6%, 85.9% and 77.4% of patients, respectively, and at 12 months 83.5% reported being continent or improved. Preoperatively 41.2% of patients reported using 1 pad or less daily, while at 1, 3, 6 and 12 months 85.6%, 90.4%, 87.2% and 86.9%, respectively, required 1 pad or less daily. Urodynamic evaluation at 12 months showed no leakage during the Valsalva maneuver in 78% of cases. There were no major postoperative complications and the minor complication rate was 5.3%. Early results of thermal treatment of the endopelvic fascia indicate that radio frequency bladder neck suspension is safe and effective for improving stress urinary incontinence in women. The improvement in symptomatology appears to be durable in most patients at the 1-year followup. Longer followup is needed to assess the durability of results and it is currently in progress.