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Published on: October 20, 2021
The Efficacy of Minimally Invasive Implantable Wireless Electrical Stimulation for the Treatment of Stress Urinary
Miho Song1, Jong Hyun Yun1, Hyun Young Lee1
1Department of Urology, Soonchunhyang University College of Medicine, Seoul, Korea.
Purpose:
Current therapies using midurethral sling mesh to treat stress urinary incontinence (SUI) are often considered insufficient. This study aims to evaluate the therapeutic efficacies of a minimally invasive implantable wireless electrical stimulator as an alternative treatment of SUI.
Methods:
SUI was induced in 12 female, 12-week-old Sprague-Dawley rats with a deteriorated urethral sphincter complex by mechanical dilatation of the vagina. Six rats underwent sham operations. Four weeks after inducing SUI, 12 rats with SUI were divided into 2 groups. One group received a transplantation of an implantable wireless electrical stimulator, and the other midline incision and suturing. A total of 4 electrical stimulations were applied for 30 minutes twice weekly for 4 weeks in implantation model. Cystometric parameters including leak point pressure, urethral pressure and electromyography, histological examinations, immunostaining for Masson trichrome stain were measured at 4 weeks after intervention.
Results:
After SUI induction, mean leak point pressure (LPP) was significantly lower in SUI groups than in controls (25.0±6.9 cm H2O vs. 62.6±4.1 cm H2O, P=0.012). At 4-week postintervention, the +ES group (SUI rat model with stimulation) demonstrated significantly higher LPP than the -ES group (48.8±8.4 cm H2O vs. 26.0±6.6 cm H2O, P=0.002). Urethral pressure showed a nonsignificant upward trend in the +ES group (SUI rat model without stimulation) compared with -ES (20.5±1.4 cm H2O vs. 18.1±1.1 cm H2O, P=0.070). Histology showed improved tissue organization with reduced inflammatory infiltration, and Masson staining demonstrated a trend toward higher collagen density in +ES (bladder: 28.3%±5.2% vs. 32.5%±7.6%, P=0.292; urethra: 44.2%±8.6% vs. 51.7%±8.2%, P=0.153).
Conclusion:
These results indicate that an implantation of a wireless electrical stimulator can help to improve urethral sphincter function in SUI rat model. Moreover, the minimally invasive wireless electrical strategy may represent a promising therapeutic modality for pelvic floor muscle rehabilitation in the treatment of SUI with potential for clinical translation.