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 around it.

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 the stimulator.

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 neurological diseases.