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Purpose: To assess the effectiveness of periurethral microballoon implantation for management of female urinary incontinence., Patients and Methods: A total of 45 women with urinary incontinence (age range 47-88 years) were treated between May 2000 and June 2001. Microballoons were placed in the proximal periurethral tissue using endoscopic instrumentation under local anesthesia. Follow-up assessment including urodynamic study and quality- of-life assessment was performed at 1, 3, and 6 months., Results: Implantation was successful in all cases with no significant adverse effects. Cure was achieved in 60% and improvement in 5%. The failure rate was 35%. Microballoon implantation significantly increased the mean urethral closure pressure, from 35.2 cm H(2)O (SD 14.9; range 15-72 cm H(2)O) to 46.5 cm H(2)O (SD 19.7; range 16-87 cm H(2)O) (P = 0.001). The best predictors of successful outcome in univariate analysis were initial urethral closure pressure (P = 0.047) and degree of incontinence (P < 0.001)., Conclusions: Periurethral microballoon implantation is a useful technique for the management of female urinary incontinence, especially in elderly and inoperable patients. The microballoons do not present the adverse effects associated with other bulking agents.

A canine model of urinary neosphincter using electrically stimulated autologous striated muscle is described. The superior belly of canine sartorius was activated by a pacemaker with an intermittent low frequency stimulation (0.5-1 pulse per sec) during 7 weeks. Then, the muscle graft was passed around the urethra and sutured back on to itself to form a neosphincter. The surgical procedure was easy to perform and with no complication. Urethral pressure profile was performed initially (T0), and when the muscle was in peri-urethral position, before (T1) and during electrical stimulation (T2). The continence parameter readings (maximal urethral closure pressure MUP, functional length FL, continence zone CZ, and continence area CA) increased from T0 to T1, and from T1 to T2. We noted: 1) 28%, 38%, 52%, and 86% increases for the MUP, FL, CZ, and CA respectively from T0 to T1, 2) 10%, 41%, 30%, and 43% increases for MUP, FL, CZ, and CA respectively from T1 to T2. Chronic low frequency stimulation could transform a skeletal fast-twitch type 2 muscle into a slow-twitch fatigue-resistant type 1 muscle. In this study, morphological changes of the stimulated muscle were noted, whereas phenotype was unchanged. This dynamic autologous neosphincter may be a new alternative to the artificial urinary sphincter prosthesis with fewer complications. Further studies are ongoing to evaluate the efficacy of such a neosphincter as continent system for bladder substitution after pelvic exenteration for pelvic cancers.

Based on a series of 209 cases, the authors investigate the aetiological factors responsible for vesical instability in adult females. Fifty five p. cent of patients suffered from incontinence due to isolated urgency. These patients presented a history of neurological disturbances in 21 cases, total hysterectomy in 22 cases and surgery for incontinence in 54 cases. Sixty p. cent of cases presented with genital prolapse. There were 7 cases of urinary tract infection, 2 cases of renal stones and 2 bladder tumours. Urodynamic studies revealed 60 dysuric syndromes. The responsibility of urinary tract infection or genital prolapse in the development of vesical instability is questionable. Nevertheless, the frequency of genital prolapse in the present series argues in favour of deficiency of the perineal musculature which decreases the capacity for inhibition of the detrusor. Lastly, 40% of patients did not have any neurological causes or any vesical or adjacent pathology. These cases were described as idiopathic vesical instability for which the aetiopathogenesis remains unknown.

Clinical and urodynamical study of 108 patients old of more than 70 years and presenting urinary incontinence showed the frequency of vesical instability and dysuria (maximum out put less than 15 ml/s).