Surgical procedures for the treatment of urge incontinence

Purpose: Cure of urge incontinence refractory to conservative management may require the application of several surgical techniques. The Ingelman-Sundberg bladder denervation procedure, detrusor myectomy, and augmentation cystoplasty are among the surgical possibilities aimed at dealing with severe urgency and uninhibited detrusor contractions. Methods and Materials: A review of the literature was performed to evaluate surgical treatments for refractory urgency and urge incontinence with a focus on the Ingelman-Sundberg bladder denervation procedure, detrusor myectomy, and augmentation cystoplasty. Results: The Ingelman-Sundberg bladder denervation has a complete response rate of 54% at a mean of 44.1 months. Among a heterogeneous group of patients, the detrusor myectomy resulted in improvement of compliance and/or resolution of uninhibited detrusor contraction in 63%. The augmentation cystoplasty has the highest overall rate of success but with a much higher likelihood of early and late postoperative complications. Conclusions: Surgical procedures for urge incontinence have a reasonable success rate with respect to cure of symptoms and urodynamic improvement when present. The possibility of cure or improvement appears to vary directly with the invasiveness of the procedure. However, a logical progression from least to most invasive should be undertaken unless very poor compliance and upper tract abnormalities dictate a more aggressive initial course of action.