Bladder neck support prosthesis of incontinence

American Family Physician,  Nov 1, 1994  

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Stress incontinence (involuntary urine loss during exertion) affects many active, community-dwelling women. Correction of the problem requires high retropubic elevation and support of the urethrovesical junction above the muscles of the pelvic floor. Treatment with surgery is highly successful in correction of incontinence but is expensive and requires a long recuperation phase. Other available treatment options include pelvic physiotherapy, pharmacologic therapy and vaginal devices. Davila and Ostermann evaluated the effectiveness of a bladder neck support prosthesis in the treatment of stress incontinence.

A total of 30 active incontinent women completed the study. All of the women were determined to have genuine stress incontinence on the basis of an incontinence history and urine loss observation during a stress test. The women were fitted with a bladder neck support prosthesis, a new vaginal device with two blunt prongs that elevate the urethrovesical junction in a manner similar to that achieved surgically. One to three attempts were required for successful fitting. After being fitted, the women were allowed to wear the device as much or as little as desired. However, they were encouraged to wear it during afl physical activities.

After four weeks, the mean number of weekly episodes of incontinence dropped from 10 to three. Women with the most severe incontinence had a more pronounced improvement in continence than women with milder incontinence. Urodynamic parameters after use were significantly improved compared with baseline. The women reported a satisfactory experience with the device; it was comfortable and easy to use. However, a few women reported that it was difficult to remove and uncomfortable during intercourse.

The authors conclude that the bladder neck support prosthesis is safe, well tolerated and as effective as surgery in the treatment of stress incontinence. Since the bladder neck support prosthesis is similar to the Smith-Hodge pessary, studies are needed to compare the efficacy of these two nonsurgical devices. (American Journal of Obstetrics and Gynecology, July 1994, vol. 171, p. 206.)

COPYRIGHT 1994 American Academy of Family Physicians
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