MODIFIED INGELMAN-SUNDBERG BLADDER DENERVATION PROCEDURE FOR INTRACTABLE URGE INCONTINENCE

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.