Sequential segmental neuromuscular stimulation reduces fatigue and improves perfusion in dynamic graciloplasty

Dynamic graciloplasty is used as a treatment modality for total urinary inc ontinence caused by a paralyzed sphincter, A problem with this application is undesirable fatigue of the muscle caused by continuous electrical stimul ation. Therefore, the neosphincter must be trained via a rigorous regimen t o transform it from a fatigue-prone state to a fatigue-resistant state. To avoid or shorten this training period, the application of sequential segmen tal neuromuscular stimulation (SSNS) was examined. This form of stimulation proved previously to be highly effective in acutely reducing fatigue cause d by electrical stimulation. The contractile function and perfusion of grac ilis muscles employed as neosphincters were compared between conventional, single-channel, continuous stimulation, and multichannel sequential stimula tion in 8 dogs. The sequentially stimulated neosphincter proved to have an endurance 2.9 times longer (as measured by halftime to fatigue) than contin uous stimulation and a better blood perfusion during stimulation (both of w hich were significant changes, p < 0.05). Clinically, this will not antiqua te training of the muscle, but SSNS could reduce the need for long and rigo rous training protocols, making dynamic graciloplasty more attractive as a method of treating urinary or fecal incontinence.