Treatment of Detrusor Instability with Electrical Stimulation

Abstract

There are an estimated 13 million Americans who suffer from incontinence. Urge incontinence is conservatively estimated to account for 40% of all urinary incontinence patients (1). Of this population, two-thirds suffer from chronic or established incontinence. Yet patients diagnosed with urinary incontinence owing to detrusor instability have had limited treatment options. Nonsurgical interventions, including diet modification, behavioral techniques (pelvic muscle exercises, biofeedback, timed voiding), drug therapies, and containment devices are commonly used to treat the condition. If these therapies are unsuccessful or unsatisfactory to the patient, surgical interventions such as bladder denervation procedures, augmentation cystoplasty, or urinary diversion may be considered. These alternatives have their own set of risks and consequences, making them unattractive to the majority of patients. According to the 1996 National Association for Continence (NAFC) survey of 2,000 incontinent persons in the US, although more treatments are available to urge incontinent patients, 63% of these patients reported they were “not satisfied” with their treatment outcomes. The lack of effective treatments for urge incontinence is particularly disturbing given the debilitating nature of this condition. Incontinent patients commonly experience loss of self-esteem, shame, depressive symptoms, embarrassment, anger, and a significant loss of quality of life (1). Urge incontinence is especially difficult given the severity and unpredictable nature of leaking episodes. Consequently, patients restrict or avoid social interactions, and have difficulties meeting daily responsibilities.