Use of Biological Feedback in Correction of Urinary Incontinence

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Abstract
Functional electrical stimulation represents a well-established method in the field of rehabilitation of urinary incontinence. Its success depends on the right choice of stimulation parameters as well as on the type of injury. Usually the effects are not satisfactory when dealing with neurogenic lesions, while it is sensible to expect good results in cases of postoperative and stress incontinence. It was often observed that after a few weeks of application of stimulator systems with intravaginal or intrarectal plugs the patient becomes continent again without the device. The method has however one disadvantage. The conditions for stress incontinence set in only temporarily, for instance when the patient is walking, coughing, etc., while the devices used for the treatment nowadays generate the stimulation pulses continuously, regardless whether the patient is incontinent at the time or not. This often tends to evoke unnecessary habituation and fatigue of the stimulated tissue. Improvements of the method can however be done. Some experiments have indicated the possibility of application of a new type of stimulation which would be turned on only in conditions for stress incontinence. Such type of stimulation is favorable from the energetic point of view, as the life of batteries can be substantially prolonged and habituation phenomena reduced. Educational effects can also be expected. For this purpose a study was done to explain the events in the urinary tract during stress incontinence. It has been assumed that the critical parameters for stress incontinence is the relation between the intraabdominal and intraurethral pressure. A hybrid model was worked out on an electronic computer, showing the actual effects of the proposed type of the stimulation. For this purpose the necessary measurements were carried out on stress incontinent patients. A laboratory test stimulation device was developed; generating stimulation pulses amplitude modulated correspondingly to the difference between the intraurethral and intraabdominal pressure. The pressures are detected by means of catheters connected to strain gauge transducers. Time delays between the start of stimulation and response of intraurethral pressure, as well as between the pressure in rectum and intravesical pressure were measured. Possibilities of various sensor locations were taken into consideration.

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