Ingelman intervention (transvaginal bladder denervation) with treatment of bladder instability

OBJECTIVES: To evaluate the clinical and urodynamic results achieved by transvaginal bladder denervation (the Ingelman technique) for bladder instability refractory to anticholinergic therapy. METHODS: The Ingelman procedure was performed in 14 female patients in whom anticholinergic therapy was unsuccessful or contraindicated. The mean age was 53.3 years (range 21-71 yrs.) and the most common presenting symptom was urge incontinence. Bladder instability persisted in 7 patients (involuntary contractions throughout the filling phase), bladder compliance was less than 30 ml/cm H20 in 7 and bladder capacity less than 300 ml in 8 patients. RESULTS: There were no intra or postoperative complications. The mean postoperative follow-up was 10.9 months (range 2-41). One patient was lost to follow-up. CLINICAL RESULTS: 10 patients (71%) reported cessation or decrease of symptoms ('clinical improvement'), 2 referred the same symptoms and 1 claimed to be worse. Urodynamic results: Some urodynamic parameters had improved in 6 of the 10 patients with clinical improvement; however, only 3 had a normal urodynamic study. Some urodynamic parameters (bladder capacity, compliance and first micturition sensation) had become worse in the 3 patients that showed no clinical improvement. There was no statistically significant improvement of the mean values of any urodynamic parameter. CONCLUSION: Transvaginal bladder denervation is a simple and safe procedure. In this series, it has achieved symptomatic improvement in 70% of patients with bladder instability. Urodynamic improvement was observed in only 3 of these patients (21%). Patients with no clinical improvement also showed worse urodynamic data postoperatively.