[Long-term results of Stamey bladder neck suspension. Effect of data analysis technique on surgical result]

[Magnet stimulation therapy: a simple solution for the treatment of stress and urge incontinence?]

AIM

Magnet stimulation therapy has been offered as a new, conservative therapy for stress and urge incontinence in Germany since 2001. Focussed, pulsating magnetic fields are used to stimulate the musculature of the floor of the pelvis. This publication describes our initial experience with this method.

PATIENTS AND METHODS

We treated 27 patients with magnetic stimulation. The individual patient sits clothed on a therapy-chair and is treated for 20 min twice a week for 2 weeks.

RESULTS

The best results were recorded in female patients with grades I and II stress incontinence who could not actively flex their pelvic-floor musculature during physiotherapy. A marked reduction in the frequency of micturition was obtained in 67% of patients with urge incontinence symptoms and non-responsiveness to anticholinergic therapy. Patients with a non-organically tangible pelvic-pain-syndrome did not benefit from the therapy.

CONCLUSIONS

Magnet stimulation therapy can act as a useful addition to conservative therapies for stress and urge incontinence. It is free of complications and does not involve the insertion of an electrode into the patient as is the case for vaginal and anal electrostimulation. However, this method does not appear to be useful for chronic, non-specific pain in the lower pelvis.

Mixed symptomatology

Mixed symptomatology, i.e. both stress and urge incontinence, is reported by patients, either of their own accord or in response to a questionnaire. Our understanding of motor urge incontinence, detrusor instability, stress incontinence and sensory urge incontinence is changing. Detrusor instability is now known to be a urodynamic observation of uncertain clinical significance. Symptoms reported by patients are not equivalent to a urodynamic diagnosis but the problem seems to be more in the urodynamics than in the symptoms. Evidence shows that sensory urge incontinence and motor urge incontinence are probably gradations of the same condition. The relationship between stress incontinence and an overactive bladder is complex. For example, neither detrusor instability nor urge incontinence appear to adversely influence the outcome of surgical treatment for stress incontinence; however, this treatment does not have a good success rate. At present, it is not clear whether this poor outcome reflects a lack of efficacy of the operations used, or their application to inappropriate patients.

A questionnaire-based outcome analysis of the Stamey bladder neck suspension procedure for the treatment of urinary stress incontinence: the Hannover experience

OBJECTIVES

To evaluate the long-term continence rate, including subjective satisfaction and therapy-associated morbidity, of patients undergoing Stamey bladder neck suspension.

PATIENTS AND METHODS

Eighty-five women (median age 55 years, range 30-85) with urinary stress incontinence treated by Stamey bladder neck suspension at our institution between 1987 and 1995 were evaluated using an anonymous questionnaire over a mean (range) follow-up of 61 (13-93) months.

RESULTS

Of the 85 patients, 44 (52%) reported an improvement in clinical symptoms at the evaluation and 29 (34%) were completely continent after the Stamey procedure. However, 53 (62%) patients reported subjective satisfaction with the result, because they had a durable improvement in continence for a mean (range) of 44 (10-79) months. There was no correlation between the number of previous urogynaecological operations undergone by the patients and the success of the Stamey procedure. However, the frequency of complications other than urinary retention was significant during and after surgery, at 27%, and in accord with the complication rate reported in earlier studies.

CONCLUSIONS

Compared with other bladder neck suspension procedures, e.g. Burch colposuspension, the Stamey procedure appears to be associated with a higher frequency of postoperative recurrent urinary stress incontinence. Therefore, the Stamey procedure should only be used if the patient demands a minimally invasive surgical procedure for bladder neck suspension. Although approximately equal to 60% of patients were satisfied with the durable improvement in clinical symptoms, it is appropriate to inform patients before surgery of the high recurrence rate after Stamey bladder neck suspension.