Nonsurgical Devices

Some men and women with stress or urge incontinence are helped with electrical stimulation devices, which help strengthen the pelvic floor muscles. Mild, painless electrical pulses are sent to these muscles through electrodes temporarily placed in the rectum or vagina.

Another stimulation device, available in some urology facilities, is the NeoControl Pelvic Floor Therapy System. This noninvasive treatment, developed by Neotonus Inc. of Marietta, Ga., is cleared for use in women with stress, urge, or mixed incontinence. The woman sits fully clothed in a special chair that aims magnetic pulses at the pelvic floor muscles. "It acts similar to the electrical muscle stimulators to improve muscle tone of the pelvic floor," says Morris.

Other device options for women with stress incontinence are urethral "plugs" and pessaries. A woman inserts a plug into the urethra, where it seals off the flow of urine. It's removed during routine urination, disposed of, and replaced with a new one as needed. Pessaries are synthetic or rubber devices of various shapes intended to occupy space within the vagina. A health professional fits and inserts a pessary into the vagina, where it helps support the pelvic organs to reduce leakage. Women who use urethral inserts and pessaries need to watch for possible urinary tract and vaginal infections.

Devices for men include clamps and compression rings that fit over the penis to squeeze the urethra shut. These must be removed to empty the bladder. Possible side effects are pain and tissue erosion when these devices are not used properly.

Implanted Devices

When other treatments have failed, implanted devices or surgery may be effective.

In a 30-minute outpatient procedure, a thick substance--made of collagen, carbon-coated beads, or other particles suspended in a solution--can be injected into the area surrounding the opening to the bladder. The substance, called a bulking agent, helps close the bladder opening to prevent leakage. Bulking agents are approved to treat stress incontinence due to poorly functioning sphincter muscles. The collagen device is approved for both women and men; others are approved only for women.

Repeat injections of bulking agents may be needed because the body slowly eliminates the substance over time. Other potential side effects are urinary tract infection, delayed ability to urinate, painful urination, urgency, frequent urination, and blood in the urine.

When men or women with overactive bladder have failed to respond to more conservative treatments, an electrical stimulation device can be placed next to the tailbone. This "pacemaker" for the bladder is marketed as InterStim Therapy by Medtronic Inc. of Minneapolis.

The treatment requires a trial period in which a doctor surgically implants a temporary electrode in the lower back. The temporary electrode is attached by a thin wire called a lead to an external stimulation device, which patients carry with them for a few days. The device sends mild electrical pulses to the nerve that controls the bladder and surrounding muscles. Patients can try it first, says Leng. "If there's dramatic improvement, then the device is permanently implanted at a second outpatient surgery, leaving all hardware under the skin."

"In clinical studies, more than one-third of the patients did not receive the implanted device typically because they did not have significant improvement during the trial period," says Morris.

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