Modified Ingelman-Sundberg Bladder Denervation Procedure for Intractable Urge Incontinence

Abstract

Purpose We determined the efficacy of the modified Ingelman-Sundberg procedure in women with urge incontinence and intractable detrusor instability. Materials and Methods Women with urge incontinence and detrusor instability, in whom medical and behavioral therapy failed, received transvaginal local anesthesia to block the terminal pelvic nerve branches to the bladder. Urge incontinence resolved temporarily in 25 patients, who subsequently underwent modified Ingelman-Sundberg transvaginal bladder denervation. All patients underwent preoperative urodynamic evaluation but documented detrusor instability was not a requirement for surgery. Results Of the patients 16 (64 percent) were cured of urge incontinence with substantial relief of detrusor instability, 2 (8 percent) had temporary improvement and 7 (28 percent) had no change. No patient who was cured required further surgery (mean followup 14.8 months, range 4 to 30). Use of anticholinergic agents also decreased dramatically: 5 patients used no, 9 used 1 and 2 used 2 medications. Detrusor instability was documented in 44 percent of the patients and was not predictive of operative outcome. There were no major complications of the procedure. Operative time was approximately 15 minutes. Conclusions In patients with urge incontinence and medically refractory detrusor instability, with few simple choices for treatment, the modified Ingelman-Sundberg procedure is an excellent surgical option that yields good results with minimal morbidity.