Rd. Cespedes et al., MODIFIED INGELMAN-SUNDBERG BLADDER DENERVATION PROCEDURE FOR INTRACTABLE URGE INCONTINENCE, The Journal of urology, 156(5), 1996, pp. 1744-1747
Purpose: We determined the efficacy of the modified Ingelman-Sundberg
procedure in women with urge incontinence and intractable detrusor ins
tability. Materials and Methods: Women with urge incontinence and detr
usor instability, in whom medical and behavioral therapy failed, recei
ved transvaginal local anesthesia to block the terminal pelvic nerve b
ranches to the bladder. Urge incontinence resolved temporarily in 25 p
atients, who subsequently underwent modified Ingelman-Sundberg transva
ginal bladder denervation. All patients underwent preoperative urodyna
mic evaluation but documented detrusor instability was not a requireme
nt for surgery, Results: Of the patients 16 (64%) were cured of urge i
ncontinence with substantial relief of detrusor instability, 2 (8%) ha
d temporary improvement and 7 (28%) 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 pati
ents used no, 9 used 1 and 2 used 2 medications, Detrusor instability
was documented in 44% of the patients and was not predictive of operat
ive outcome, There were no major complications of the procedure, Opera
tive 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 proce
dure is an excellent surgical option that yields good results with min
imal morbidity.