BLADDER NECK SUPPORT PROSTHESIS - A NONOPERATIVE TREATMENT FOR STRESSOR MIXED URINARY-INCONTINENCE

Purpose: We evaluated the usefulness and safety of a bladder neck supp ort prosthesis in patients with stress or mixed incontinence. Material s and Methods: A total of 57 women with stress and 20 with mixed incon tinence completed a 12-week prospective clinical trial of a bladder ne ck support prosthesis. While indexes of incontinence episodes, leakage amounts and urgency along with a bothersome index were subjectively e valuated, a 60-minute pad test and urinary flow parameters were object ively evaluated. Three patients scheduled to undergo surgery for stres s incontinence voluntarily used the device, and provided urodynamic da ta and cystourethrograms. Two prongs at 1 end of the ring, a type of e lastic vaginal pessary, elevate the bladder neck against the pubic bon e and facilitate pressure transmission around the bladder neck, result ing in urinary continence. Results: Four subjective indexes significan tly improved. There was no urinary flow obstruction. Urine loss decrea sed from 20.6 to 4.8 gm. per hour (p < 0.001) on the 60-minute pad tes t. Of the patients 22 (29%) reported complete continence and 39 (51%) had decreased severity of incontinence by more than 50%. Minor adverse effects occurred in 26% of the patients. Taking subjective evaluation , changes in objective parameters and adverse effects into considerati on, 62 patients (81%) had some or maximum benefit according to the glo bal usefulness rating. Conclusions: The bladder neck support prosthesi s is safe, well tolerated and clinically effective for the treatment o f stress or mixed incontinence.