Muscular Urinary Sphincter: Electrically Stimulated Myoplasty for Functional Sphincter Reconstruction

Palacio, Martin M.; Aalst, Vera C. van; ABADIA, G. A. PEREZ; Stremel, Richard W.; Werker, Paul M. N.; Ren, X.; Petty, G.D.; Heilman, Steven J.; Savage, John G. Van; Fernández, Ángel García; Kon, Moshe; Tobin, Gordon R.; Barker, John H.

doi:10.1016/s0022-5347(01)62434-0

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…Williams et al [15] and Janknegt et al [16] reintroduced this procedure by adding implantable pulse generators to induce gracilis muscle contractions, but clinical outcomes were far from satisfactory. Stricture of the transplanted muscle flap was one of the complications that led to difficulties with urination, possibly due to ischemia in the distal part of the gracilis muscle [17,18]. …”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Urethral Sphincter with Dynamic Graciloplasty in a Male Rabbit Model

Uchikawa-Tani

Yazawa²,

Sakuma

et al. 2015

Urol Int

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Introduction: The use of artificial urinary sphincters can improve urinary incontinence after radical prostatectomies; however, complications can arise. We hypothesized that dynamic graciloplasty improves urethral sphincter reconstruction. Materials and Methods: Models of urethral sphincter muscle reconstruction were developed in 5 adult rabbits by wrapping the gracilis muscle flap around the urethra. Intra-urethral pressure was measured in each of the models before reconstruction (control), after reconstruction, and after electrical stimulation of the flap in reconstructed models (stimulated models). Results: The mean maximum urethral closure pressure was significantly greater in the reconstruction model (69.7 (66.5-115.8) mm Hg) than in the control model (39.2 (33.7-49.6) mm Hg). The mean integral of the urethral pressure and urethral length was also significantly greater in the reconstruction model than in the control model. Furthermore, sphincter tightening was enhanced by the electrical stimulation of the flap. Conclusions: Our results support our hypothesis that the functional reconstruction of urethral sphincters using muscle flaps is promising for the treatment of urinary incontinence.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of the Urethral Sphincter with Dynamic Graciloplasty in a Male Rabbit Model

Uchikawa-Tani

Yazawa²,

Sakuma

et al. 2015

Urol Int

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“…[17][18][19] This variation provides ample muscle length and makes it possible to use the proximal, well-perfused part of the gracilis muscle to wrap around the urinary outlet. This approach also makes it possible to wrap the gracilis muscle concentrically like a true sphincter.…”

Section: Discussionmentioning

confidence: 99%

“…The protocol used was that specified by the U.S. Food and Drug Administration for clinical dynamic graciloplasty. 19 After this 8-week training regimen, all MUSs were programmed to be on for 4 hours and off for 15 minutes in continuous cycles. Urodynamic measurements.…”

Section: Long-term Mus Functionmentioning

confidence: 99%

“…Based on the above hypothesis, we have introduced a new procedure [17][18][19] whereby the gracilis muscle is detached from its proximal attachment and constructed into a free flap by dividing the main vascular pedicle, leaving its nerve supply intact. Using this free-flap approach, the wellperfused part of the gracilis (close to where the vascular pedicle enters the muscle) can be used to construct the neosphincter.…”

mentioning

confidence: 99%

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Gracilis muscle neosphincter for treating urinary incontinence

et al. 2001

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The purpose of this study was to test the anatomical and functional feasibility of using a gracilis muscle free flap to create a urinary sphincter. Anatomical studies were performed in 12 human cadavers and short-term (n = 7) and long-term (n = 8) functional studies were performed in dogs. In the short-term functional studies, the left gracilis muscle was transferred into the pelvis and wrapped around the urethra and the right gracilis muscle was wrapped around a stent. A cuff electrode was placed on the muscle's nerve pedicle and used to stimulate the neosphincter while peak pressure, fatigue rate, and perfusion measurements were performed. In the long-term functional studies, intramuscular electrodes were inserted into the neosphincter to stimulate the flap. The flaps were wrapped around the urethra and dogs were followed for 16 weeks, during which time urodynamic measurements were performed. Our anatomical studies demonstrated that the gracilis muscle free flap could be transferred into the pelvis to create a urinary neosphincter. Our short-term functional study demonstrated that gracilis muscle free-flap function and perfusion were not compromised by transfer. In our long-term functional study, all neosphincters provided bladder outlet resistance pressures consistent with continence. Our anatomical, short-term, and long-term functional studies indicate that a gracilis muscle free-flap neosphincter is an effective procedure for treating urinary incontinence.

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“…Based on these previous reports and our laboratory's experience using dynamic myoplasty techniques for a variety of applications, [25][26][27][28] it was believed that a continent stoma sphincter could be designed and could provide continence for at least several hours. A multiphase project was undertaken that was designed to solve the critical issues of denervation atrophy and early muscle fatigue.…”

Section: Microsurgery 21:248-255 2001mentioning

confidence: 99%

Dynamic rectus abdominis muscle flap for intestinal stomal continence: A systematic approach

et al. 2001

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Several attempts to create a continent stomal sphincter using dynamic myoplasty with limited success have been reported. Denervation atrophy and early muscle fatigue have plagued all reported attempts to make a continent stoma a reality. To address this problem in a series of experiments, we designed a stomal sphincter using the most caudal segment of the rectus abdominis muscle. Then, we performed a study to determine whether a sphincter created with a rectus abdominis muscle island flap could maintain stomal continence in the short term. We found that when stimulated using two different electrical stimulation protocols, in all cases the rectus abdominis muscle sphincter generated peak pressures well above those needed to maintain stomal continence (60 mm Hg). All sphincters were able to maintain stomal continence at all intraluminal bowel pressures tested. We found one of these protocols to be far superior and reached 4 hours of stomal continence after 8 to 10 weeks of electrical stimulation.

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Muscular Urinary Sphincter: Electrically Stimulated Myoplasty for Functional Sphincter Reconstruction

Abstract: This electrically stimulated innervated free-flap MUS technique effectively increases bladder outlet resistance without producing urethral obstruction.

Cited by 12 publications

References 17 publications

Reconstruction of the Urethral Sphincter with Dynamic Graciloplasty in a Male Rabbit Model

Reconstruction of the Urethral Sphincter with Dynamic Graciloplasty in a Male Rabbit Model

Gracilis muscle neosphincter for treating urinary incontinence

Dynamic rectus abdominis muscle flap for intestinal stomal continence: A systematic approach

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