Jefferson Urologists Explore Use of Leg Muscle For Urinary Incontinence
Jefferson is the first center in the United States to participate
in this novel clinical trial.
Urologists at Jefferson Medical College are exploring the use of a new surgical
technique to treat urinary incontinence. The procedure, gracilis urethromyoplasty,
involves transferring an electrically stimulated leg muscle to act as a
urinary sphincter. It is especially suitable for men affected with stress
urinary incontinence associated with prostate surgery.
Gracilis urethromyoplasty is accomplished by first mobilizing the gracilis
muscle through a thigh incision. The gracilis muscle extends from the top
of the inner thigh down to the knee. Second, a perineal incision is made
providing access to the urethra, and the gracilis muscle is completely wrapped
Once the muscle is transferred, two electrodes are implanted near the nerve
to the muscle to achieve maximal contraction. This is first demonstrated
during intraoperative stimulation. Next, the electrodes are tunneled up
to the lower abdomen where they are connected to an electrical pulse stimulator,
which is placed under the skin.
After implantation, adjustment of the pulse stimulator during an eight-week
progressive stimulation program transforms the gracilis muscle from intermittent
to full sphincter function. Patients can urinate by inactivating the gracilis
sphincter with a small magnet which is held on or close to the skin overlying
According to principal investigators Michael B. Chancellor, MD, associate
professor of urology, and David A. Rivas, MD, assistant professor of urology,
this procedure creates a fully functional sphincter and assures continence
for the patient.
The advantage of this approach is urinary continence without the risks of
infection, tissue erosion and device malfunction, which are associated with
artificial urinary sphincter placement, they continue.
Gracilis urethromyoplasty has shown promising results to date and can be
especially helpful for those with stress urinary incontinence, which is
a devastating medical and social condition. Appropriate candidates include
men who are incontinent after prostate surgery, men and women who have failed
previous incontinence surgery and patients with incontinence secondary to