Corporofundal partial peripheral bladder denervation as surgical therapy of urge incontinence

Abstract

Urge incontinence places a considerable burden on incontinence treatment. The autonomous nerve supply of the bladder is effected via two anatomically clearly separate ways. On the one hand, we have the accessory innervation via the fascia endopelvina, whereas on the other hand fibres from the plexus pelvicus as the classical site of innervation penetrate into the bladder. Transection of the fascia endopelvina followed by detachment of the plexus pelvicus from the lateral bladder wall in the course of separation of the bladder and levator enables corporofundal partial peripheral bladder denervation. By this procedure both afferent and efferent nerve fibres are transected. As a result, excess autonomous impulses are reduced, thus effecting favourable reduction of the urge incontinence pattern. This method is quite fascinating not only because it is easily translated into practice, offers ideal vaginal access, and is reproducible at all times, but also because it can be utilised as a therapeutic tool in the treatment of urge incontinence, and because it can be integrated in an optimal manner into the standard incontinence and descensus programme. A failure rate of 3% is hardly ever exceeded. Compared with the other methods described so far, which are mostly very severe in their effect and highly specialised, the advantages of corporofundal partial peripheral bladder denervation point towards considerable chances to translate the method into practical reality.