Selection of patients with urinary incontinence for application of functional electrical stimulation

Contradictory data from the literature along with our own experience using functional electrical stimulation (FES) have facilitated the determination of objective criteria for the application of FES in correcting urinary incontinence. Simultaneous urodynamic, neurophysiological, and radiological examinations employed during our studies enabled us to determine changes in these parameters due to FEX. Among a large number of patients with urinary incontinence (for example: paraplegics, patients with spina bifida, stress incontinence following prostate operations, or resistant enuresis) we have determined that FES is appropriate if applied to properly selected patients. FES is indicated on the basis of the following criteria: the degree of morphological lesion of the urinary tract, the peripheral denervation of the muscles of the pelvic floor, the condition of the spinal center for miction, and, above all the quality of response to FES. FES not only activates the closing muscles of the bladder, but also inhibits the reflex contractions of the detrusor. Here, it should be noted that FES is indicated for cases of reflex incontinence. During FES of the pelvic floor muscles intravesical pressure normally diminishes and the reflex contractions of the detrusor subside. Sometimes, however, the reflex of miction occurs. In such a case, two reflex mechanisms are engaged. Their equilibrium, i.e. controlled miction, can be achieved with an afferent in flow which inhibits the reflex of miction. The use of FES for the correction of urinary incontinence can be a very good method if the FES parameters are individually chosen and patients properly selected.