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Non-invasive Magnetic Stimulation for the treatment of stress, urge and mixed urinary incontinence.

This treatment is called Neocontrol Pelvic Floor Therapy and has been utilised for faecal incontinence, male post radical prostatectomy incontinence, overactive bladder, post partum incontinence as well as stress, urge and mixed urinary incontinence. It is based on Extracorporeal Magnetic Innervation or ExMI™ technology. ExMI™ works by building strength and endurance in the muscles of the pelvic floor.

The treatment involves the patient sitting, fully clothed, on a specially designed chair for 22 minutes of therapy. The treatment is administered by a Registered Nurse under the supervision of an Urologist. Generally the therapy is well tolerated and 2-3 sessions a week are recommended over a 6-8 week period. To obtain maximum benefit from this treatment it is advised that the 6-8 week period is completed consecutively without interruption.

The cost per treatment is $40.00 GST inclusive.

There are several contraindications to using Neocontrol therapy which could preclude some patients. These include:

1. Patients who are pregnant

2. Patients who have an implantable cardiac pacemaker or cardioverter defibrillator

3. Patients with a history of cardiac arrhythmia

To obtain more details about this treatment or to book a treatment time please contact us direct on (07) 577 7800.

If you would like to access published scientific data please click on any of the website links below:

Garstka-Namysł, K.a e , Brȩborowicz, G.H.b , Pilaczyńska-Szcześniak, Ł.a , Huber, J.c , Sajdak, S.d , Pisarska, M.d , Witczak, K.d , Sroka, Ł.d , Witkowska, A.c
Functional stimulation of perineal muscles in women with urinary incontinence after gynecological surgery and its effect on quality of life changes [Stymulacja czynnościowa miȩśni dna miednicy u kobiet po operacjach ginekologicznych z objawami nietrzymania moczu i jej wpływ na zmianȩ jakości życia]
(2007) Fizjoterapia Polska, 7 (2), pp. 124-132.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-36649025931&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Leisure and Recreation Pdagogy, Laboratory of Recreational Sports, University of Physical Education, Poznań, Poland;
Department of Perinatology and Gynaecology, Karol Marcinkowski Medical University, Poznań, Poland;
Division of Locomotor Pathophysiology, Karol Marcinkowski Medical University, Poznań, Poland;
Department of Surgical Gynaecology, Karol Marcinkowski Medical University, Poznań, Poland;
os. Stefana Batorego 15H/6, 60-687-Poznań
ABSTRACT: Background. Urinary incontinence and disturbances of perineal muscle and nerve activity in women after gynecological surgery have a major influence on the patients' quality of life. Using global EMG data, it is possible to customize parameters for spinal FES and perineal EMS treatments and to objectively assess treatment outcomes. Material and methods. 15 women after gynecological surgery with disturbances of micturition underwent gynecological and urodynamic assessments, sonography, global EMG with a vaginal probe and magnetic field-induced motor evoked potentials (MEP) tests. The parameters for EMS and FES were customised on the basis of those diagnostic tests and the treatments were self-administered by patients for 2 months. Quality of life changes were assessed with Prof. Kowalik's quality of life assessment scale at baseline and at the end of the treatment. Results. In 12 patients, EMG and MEP recordings revealed that the disturbances were caused by axonal degeneration of motor fibres rather than by impaired impulsation at the spinal centre level. Mean values of perineal muscle resting potentials were 2.52 μV before and 1.87 μV after treatment. Contraction strength rose from 14.7 μV to 16.9 μV. The self-reported 20-Jomain quality of life scale showed increased current and future-oriented satisfaction with life. Conclusions. A two-month cycle of FES and EMS improved motor unit function at maximum contraction. MEP studies revealed improved conduction from spinal motor centres to muscles, especially if EMS of perineal muscles had been supplemented with lumbo-sacral FES. © Medsportpress, 2007.
AUTHOR KEYWORDS: ETS and EMG biofeedback; Perineal muscles; Quality of life; Spinal functional electrical stimulation (FES); Surface electromyography; Urinary incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

Suzuki, T.a , Yasuda, K.a , Yamanishi, T.a b , Kitahara, S.a , Nakai, H.a , Suda, S.a , Ohkawa, H.a
Randomized, double-blind, sham-controlled evaluation of the effect of functional continuous magnetic stimulation in patients with urgency incontinence
(2007) Neurourology and Urodynamics, 26 (6), pp. 767-772.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-35148853762&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Koshigaya Hospital, Dokkyo Medical University, Saitama, Japan;
Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
ABSTRACT: Aims: To evaluate the effect of functional continuous magnetic stimulation (FCMS) on urgency incontinence in randomized, sham-controlled manner. Methods: Thirty-nine patients with urgency incontinence, 16 males and 23 females (aged 66.0 ± 16.5 years), who were refractory to pelvic floor muscle training (PFMT), were randomly assigned either to the treatment schedule performing 10-week active treatment, followed by 4-week non-treatment interval and then by 10-week sham treatment (A-S, n = 20) or to that performing the sham treatment first followed by 10-week active treatment (S-A, n = 19). Results: At 10 weeks, the number of leaks/week, the total score of the International Consultation on Incontinence-Questionnaire: Short Form (ICIQ-SF), and maximum cystometric capacity (MCC) were significantly improved as compared with the initial levels (P < 0.001, P < 0.001, and P = 0.003, respectively) in the former group, but not in the latter group. Four (20.0%) patients were cured in the A-S group, while no patient was cured in the S-A group.At the end of the A-S schedule (24 weeks of study), the effect of the active treatment was still maintained at a significantly improved level, as compared with the initial level. At the end of the S-A schedule, the number of leaks/week was significantly improved as compared with the initial level and with its 10-week level (P < 0.001 and P = 0.049, respectively), as well as ICIQ-SF total score (P = 0.001 and P = 0.006, respectively). MCC significantly increased from its initial level (P = 0.030). Conclusion: Magnetic stimulation was effective on urgency incontinence in comparison to sham stimulation in this small patient group. © 2007 Wiley-Liss, Inc.
AUTHOR KEYWORDS: Incontinence; LUTS; Magnetic stimulation; Pelvic floor muscle training (PFMT); Urgency; Urodynamic study
DOCUMENT TYPE: Article
SOURCE: Scopus

Manganotti, P.a e , Zaina, F.a , Vedovi, E.b , Pistoia, L.c , Rubilotta, E.d , D'Amico, A.d , Falso, M.a
Repetitive magnetic stimulation of the sacral roots for the treatment of stress incontinence: A brief report
(2007) Europa Medicophysica, 43 (3), pp. 339-344.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-36049000502&partnerID=40&rel=R8.0.0
AFFILIATIONS: Unit of Neurological Rehabilitation, Department of Neurological and Visual Sciences, University of Verona, Verona, Italy;
Service of Functional Reeducation, Policlinico G.B. Rossi, Verona, Italy;
Unit of Obstetrics and Gynecology, S. Bonifacio Hospital, S. Bonifacio, Verona, Italy;
Department of Urology, Policlinico G. B. Rossi, Verona, Italy;
Dipartimento di Scienze Neurologiche e della Visione, Sezione di Neurologia Riabilitativa, Policlinico G.B. Rossi, Piazza A. Scuro, 37134 Verona, Italy
ABSTRACT: Aim. The aim of this study was to investigate the short and long-term effects of repetitive magnetic stimulation on the sacral roots in a homogeneous group of patients affected by stress incontinence. Methods. Twenty women with urinary stress incontinence were randomly assigned to an active or a sham stimulation group. Fifteen-Hz repetitive magnetic stimulation of the sacral roots (S2-S4) was applied for 15 min. Patients were treated with magnetic stimulation for 3 days a week for 2 weeks (6 times in all). The clinical outcome was assessed before (T1) and 1 week (T2) and 1 month (T3) after stimulation. Main outcome measures were: the King's Health Questionnaire, the SJEAPI-QMM scale and the amount of urinary loss in a 1-h pad test and stress test. Results. At T2 patients in the active stimulation group showed improvement in health perception (P<0.001), social limitation (P<0.01), sleep/energy performance (P<0.05) and severity measure score (P<0.05) not observed in the sham stimulation group; a significant decrease in SEAPI-QMM score was noted only in the active group at T2 (P<0.05). These results were no longer observed at T3. We also observed a decrease in the amount of urine loss quantified with the pad test and stress test in the active stimulation group. Conclusion. Repetitive magnetic stimulation of the sacral roots has a short-term effect on some aspects of the quality of life of the patients, but it did not prove effective using quantified measurement.
AUTHOR KEYWORDS: Electrical stimulation; King's health questionnaire - Neurological bladder; Magnetic stimulation; Pelvic floor; Sacral root; Stress incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

Fowler, C.J.
Editorial Comment on: Extracorporeal Magnetic Stimulation is of Limited Clinical Benefit to Women with Idiopathic Detrusor Overactivity: A Randomized Sham Controlled Trial
(2007) European Urology, 52 (3), pp. 882-883.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-34547147481&partnerID=40&rel=R8.0.0
AFFILIATIONS: Institute of Neurology, UCL
DOCUMENT TYPE: Article
SOURCE: Scopus

Choe, J.H.a , Choo, M.-S.b , Lee, K.-S.c
Symptom change in women with overactive bladder after extracorporeal magnetic stimulation: A prospective trial
(2007) International Urogynecology Journal and Pelvic Floor Dysfunction, 18 (8), pp. 875-880. Cited 1 time.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-34447124343&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Cheil General Hospital, Sungkyunkwan University School of Medicine, 1-19 Mukjeong-dong, Jung-gu, Seoul 100-380, South Korea;
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap- 2 dong, Songpa-gu, Seoul 138-736, South Korea;
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea
ABSTRACT: The purpose of this study was to prospectively evaluate symptom change after discontinuation of extracorporeal magnetic stimulation (EMS) in women with overactive bladder (OAB). A total of 48 women with OAB were included. We applied 10 Hz of repetitive magnetic stimulation with a "magnetic chair" for 20 min, twice weekly for 8 weeks. Changes in OAB symptoms at 2, 12, and 24 weeks after discontinuing the EMS were evaluated. Twenty-seven (56.3%) patients were cured compared with the baseline at 2 weeks: the cure rate was determined as 68.8% (33/48 patients), 56.3% (27/48), and 50% (8/16) for urgency, frequency, and urge incontinence, respectively. The mean number of voids per 24 h was decreased by 42.8% (from 14.5±4.3, to 8.3±1.5, P<0.001) at 2 weeks after treatment. Maximum voided volume did not change significantly, but the mean voided volume increased significantly after stimulation. Twenty-six (96.3%) patients among the 27 patients who achieved a cure at 2 weeks, maintained improvement at 24 weeks; the therapeutic effect on urgency, frequency, and urge incontinence persisted in 26 (78.8%) of 33 patients, 26 (96.3%) of 27 patients, and six (75%) of eight patients, respectively. There were no significant changes in urodynamic parameters. Of the 14 patients with detrusor overactivity, the condition was no longer observed in four (28.6%) patients. EMS has a beneficial effect on women with OAB. Our data suggest EMS may have a significant carry-over effect in well-selected OAB patients. © International Urogynecology Journal 2006.
AUTHOR KEYWORDS: Bladder; Magnetics; Prospective studies; Therapy; Urinary incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

MacDonald, R.b , Fink, H.A.b , Huckabay, C.c , Monga, M.c , Wilt, T.J.a b
Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: A systematic review of effectiveness
(2007) BJU International, 100 (1), pp. 76-81. Cited 2 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-34249932481&partnerID=40&rel=R8.0.0
AFFILIATIONS: Minneapolis VA Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417, United States;
Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research, Cochrane Review Group in Prostate Diseases and Urologic Cancers, Minneapolis, MN, United States;
Department of Urology, Veterans Affairs Medical Center, Minneapolis, MN, United States
ABSTRACT: OBJECTIVE: To evaluate the effectiveness of pelvic floor muscle training (PFMT) for treating urinary incontinence (UI) after radical prostatectomy (RP) by reviewing evidence from randomized trials. METHODS: Randomized trials published in English were included if they involved men with UI after RP and compared PFMT with a control group. Data were abstracted onto a standardized form using a prospectively developed protocol. RESULTS: Eleven trials randomizing 1028 men (mean age 64 years) met the inclusion criteria; the duration of the trials was 3-12 months. One trial of 300 men found that those assigned to PFMT achieved continence more quickly (after 1, 3 and 6 months) than men not assigned to PFMT. Men receiving biofeedback-enhanced PFMT were more likely to achieve continence or have no continual leakage than those with no training within 1-2 months after RP (relative benefit increase 1.54; 95% confidence interval 1.01-2.34; four trials reporting). The relative benefit increase (1.19, 0.82-1.72; five studies) was no longer significant after 3-4 months. Biofeedback-enhanced PFMT was comparable to written/verbal PFMT instruction. Extracorporeal magnetic innervation (ExMI) and electrical stimulation (ES) were found to be initially (within 1-2 months) more effective than PFMT in one trial, but there were no significant differences between groups at ≥ 3 months. CONCLUSION: Based on available evidence, PFMT with or without biofeedback enhancement hastens the return to continence more than no PFMT in men with UI after RP. Additional trials are needed to confirm whether ExMI and ES are effective conservative treatment options. © 2007 BJU International.
AUTHOR KEYWORDS: Pelvic floor muscle training; Radical prostatectomy; Systematic review; Urinary incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

Kirschner-Hermanns, R.a b , Jakse, G.a
Magnetic stimulation of the pelvic floor in older patients. Results of a prospective analysis [Magnetstimulation des beckenbodens beim älteren menschen. Ergebnisse einer prospektiven untersuchung]
(2007) Urologe - Ausgabe A, 46 (4), pp. 377-381.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-34247257211&partnerID=40&rel=R8.0.0
AFFILIATIONS: Urologische Klinik, Rheinisch-Westfälische Technische Hochschule, Universitätsklinikum, Aachen, Germany;
Urologische Klinik, Rheinisch-Westfälische Technische Hochschule, Universitätsklinikum, Pauwelsstraße 30, 52057 Aachen, Germany
ABSTRACT: Since 2001 magnetic stimulation therapy has been available in Germany for treating urinary incontinence as an alternative to traditional electrical stimulation therapy. The results of 83 patients who underwent magnetic stimulation therapy for stress incontinence, OAB, and pelvic pain syndrome were evaluated. The results differed depending on the underlying disease. Patients with stress incontinence who could not properly contract pelvic floor muscles before could do so in 74% when clinically evaluated and patients with OAB symptoms improved in 54% as assessed by objective and subjective criteria, whereas patients with pelvic pain syndrome only benefited in 23%. Comparison of the results according to age revealed no significant difference between patients >65 years and younger patients. © 2007 Springer Medizin Verlag.
AUTHOR KEYWORDS: Chronic bladder pain; Electrostimulation therapy; Magnetic stimulation therapy; Stress incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

Shobeiri, S.A.a e , Chesson, R.R.b , West, E.C.a , Shott, S.c , Hoyte, L.d
A pilot study of extracorporeal magnetic stimulation of the pelvic floor for the treatment of women with fecal incontinence and underactive pelvic floor muscles
(2007) Journal of Pelvic Medicine and Surgery, 13 (1), pp. 19-26.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-33846826972&partnerID=40&rel=R8.0.0
AFFILIATIONS: University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States;
Louisiana State University Health Sciences Center, New Orleans, LA, United States;
Department of Biostatistics, Rush University, Chicago, IL, United States;
Harvard Medical School, Boston, MA, United States;
University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, 920 Stanton L. Young Blvd., Oklahoma City, OK 73190, United States
ABSTRACT: OBJECTIVES: The goal of the current study was to ascertain if patients with fecal incontinence and underactive pelvic floor muscles benefit from extracorporeal magnetic stimulation (EXMI) treatments. METHODS: Evaluations were performed at 0, 2, 4, 6, 8, 12, and 24 weeks using the Cleveland Clinic Fecal Incontinence Score (CCFIS). Six subjects underwent pretreatment and posttreatment MR-based 3-dimensional measurement of the levator ani muscle volume. Sixteen patients completed the study. RESULTS: Compared with scores at week 0, statistically significant improvements in CCFIS were seen at week 6 and week 8 (P = 0.048 and P = 0.024, respectively). At 12 weeks, the mean CCFIS returned to the level seen at week 0. The mean levator ani volume was higher after EXMI compared with baseline (P = 0.1). The resting and squeeze pelvic floor/vaginal pressure measurements showed a statistically significant improvement. CONCLUSIONS: This study suggests that EXMI may transiently improve symptoms in fecal incontinent women with underactive pelvic floor muscles. © 2007 Lippincott Williams & Wilkins, Inc.
AUTHOR KEYWORDS: Extracorporeal magnetic innervation; Fecal incontinence; MRI; Underactive pelvic floor
DOCUMENT TYPE: Article
SOURCE: Scopus

Voorham-Van Der Zalm, P.J.a c , Pelger, R.C.M.a , Stiggelbout, A.M.b , Elzevier, H.W.a , Lycklama À Nijeholt, G.A.B.a
Effects of magnetic stimulation in the treatment of pelvic floor dysfunction
(2006) BJU International, 97 (5), pp. 1035-1038. Cited 3 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-33645738960&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Leiden University Medical Center, Netherlands;
Department of Medical Decision Making, Leiden University Medical Center, Netherlands;
Department of Urology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
ABSTRACT: OBJECTIVE: To correlate, in a pilot study, the clinical results of extracorporeal magnetic innervation therapy (ExMI) of the pelvic floor muscles with functional changes in the pelvic floor musculature, urodynamics and quality of life. PATIENTS AND METHODS: In all, 74 patients (65 women and nine men) with urge incontinence, urgency/frequency, stress incontinence, mixed incontinence and defecation problems were included in a prospective study of ExMI using a 'electromagnetic chair'. All patients were treated twice weekly for 8 weeks. Digital palpation and biofeedback with a vaginal or anal probe were used for registration of the pelvic floor musculature. A urodynamic evaluation, a voiding diary, a pad-test, the King's Health Questionnaire (KHQ) and a visual analogue scale (VAS) were completed by the patient at baseline and at the end of the study. RESULTS: In the group as a whole, there were no significant differences in the voiding diary, pad-test, quality of life, VAS score, biofeedback registration and urodynamics before and after treatment. Additional stratification was applied to the total patient group, related to the pretreatment rest tone of the pelvic floor, the basal amplitude registered on electromyography, to age and to previous treatments. However, there were no significant differences in the data before and after treatment within all subgroups (stress incontinence, urge incontinence, urgency/frequency, defecation problems, overactive pelvic floor, age, previous treatments), except for the KHQ domain of 'role limitations', where there was a significant improvement in all groups. CONCLUSION: ExMI did not change pelvic floor function in the present patients. The varying outcomes of several studies on ExMI stress the need for critical studies on the effect and the mode of action of electrostimulation and magnetic stimulation. In our opinion 'the chair' is suitable to train awareness of the location of the pelvic floor. However, active pelvic floor muscle exercises remain essential. © 2006 BJU International.
AUTHOR KEYWORDS: Electrostimulation; Incontinence; Magnetic stimulation; Pelvic floor
DOCUMENT TYPE: Article
SOURCE: Scopus

Zhou, N., Lu, M., Chen, Z.
A study on the treatment efficiency of functional magnetic stimulation and sacral nerve stimulation in patients with neurogenic dysfunction of bladder and urethra
(2006) Chinese Journal of Rehabilitation Medicine, 21 (1), pp. 35-37.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-33644660838&partnerID=40&rel=R8.0.0
AFFILIATIONS: Dept. of Rehabilitation Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
ABSTRACT: Objective: To assess the efficiency of functional magnetic stimulation (FMS) and sacral nerve stimulation (SNS) in patients of neurogenic dysfunction of bladder and urethra. Method: 20 patients with neurogenic bladder and urethra received FMS of the sacral nerves at S3 and in bladder area. 12 patients received SNS treatment. Result: There were significant improvements in both FMS and SNS groups after treatment with regarding to number of voiding, volume voided and degree of frequency, urgency and incontinence (P<0.01-0.001), the score of quality of life and LUTS (P<0.001). Conclusion: Both FMS and SNS are effective to successfully treat patients with neurogenic dysfunction of bladder and urethra and improve the patients' quality of life.
AUTHOR KEYWORDS: Functional magnetic stimulation; Neurogenic dysfunction of bladder and urethra; Quality of life; Sacral nerve stimulation
DOCUMENT TYPE: Article
SOURCE: Scopus

Bölükbaş, N.a , Vural, M.a , Karan, A.a , Yalçin, Ö.b , Eskiyurt, N.a
Effectiveness of functional magnetic versus electrical stimulation in women with urinary incontinence
(2005) Europa Medicophysica, 41 (4), pp. 297-301. Cited 1 time.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-31644434148&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey;
Department of Obstetrics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
ABSTRACT: Aim. Urinary incontinence is one of the most common medical complaints in women. We here propose to evaluate and compare the effects of 2 conservative treatment modalities, functional electrical stimulation (FES) and functional magnetic stimulation (FMS). Methods. We studied 22 female patients with urinary incontinence and divided them into 2 treatment groups (14 patients in the FES and 8 in the FMS group). The mean age of the patients in the FES group was 51.14±11.9 and in the FMS group 42.25±6.9 years. Functional electrical stimulation was applied continuously at 10 Hz and 30-50 Hz in urge and stress urinary incontinence respectively. In mixed urinary incontinence stimulation was applied at 10 Hz for 15 min and at 50 Hz for 15 min. The treatment sessions were for 20 min, 3 times a week for 6-8 weeks (12 with mixed, 2 with stress incontinence). FMS was applied by a magnetic chair, twice weekly for 6 weeks (6 with mixed, 1 with stress urinary and 1 with urge urinary incontinence). The efficacy of the treatment was judged from patient impressions, records in urinary diaries, results of 1 h pad test, perineometry value and digital palpation score. Results. The perineometry value, digital palpation score increased significantly during stimulation compared with prestimulation levels in both groups (P<0.05). For the pad test significant improvement was also noted in both groups (P<0.05). The urinary diaries and frequency of micturition were significantly more cured or improved in the FES group (P<0.05). However, reduction of the frequency of nocturnal micturition was n't significant in either group (P>0.05). Conclusion. Both FES and FMS treatments were effective. FMS does not involve intravaginal stimulation and it is twice a week. Although FMS is not often used it is more cost effective than FES. In order to have exact knowledge of this issue; more research than has been done in a greater number of subjects is required.
AUTHOR KEYWORDS: Electrical stimulation; Urinary incontinence; Women
DOCUMENT TYPE: Conference Paper
SOURCE: Scopus

Thornton, M.J.a b , Kennedy, M.L.a , Lubowski, D.Z.a
Extracorporeal magnetic stimulation of the pelvic floor: Impact on anorectal function and physiology. A pilot study
(2005) Diseases of the Colon and Rectum, 48 (10), pp. 1945-1950. Cited 1 time.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-26444614279&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Colorectal Surgery, St. George Hospital, University of New South Wales, Kogarah, NSW, Australia;
8 Belmont Cres, Glasgow, G12 8EU, United Kingdom
ABSTRACT: PURPOSE: This study was designed to investigate the effect of extracorporeal magnetic stimulation on anorectal function and physiology. METHODS: A pilot study comparing the physiology of ten incontinent (9 females) and five continent (4 females) patients with and without perineal magnetic stimulation (10 Hz and 50 Hz) was performed. The ten incontinent patients were treated with two sessions weekly for five weeks of perineal magnetic stimulation. At treatment completion, precontinent and postcontinent scores and resting and squeeze anal pressure were compared. Patients also reported symptom improvement and satisfaction on a linear analog scale. RESULTS: The patients' mean age was 57 years. Sitting resting and squeeze anal pressures were significantly greater than lying pressures (P = 0.007, 0.047). Both 10-Hz and 50-Hz stimulation effected a significant increase in anal pressures compared with the baseline resting pressure (P = 0.005). The baseline squeeze pressures were significantly higher than the stimulated pressures compared with 50-Hz pressures (P = 0.022). After six weeks of treatment, there was a statistically significant increase in resting and squeeze anal pressures and a significant decrease in continence scores (P = 0.007, P = 0.008, P = 0.017). The mean percentage subjective improvement was 16 percent, and the mean patient satisfaction score was 3.3, positively correlating with an improvement in the continence score. CONCLUSIONS: Extracorporeal magnetic stimulation results in a significant increase in anal resting pressure irrespective of pretreatment continence. Although the subjective improvement in continence after treatment is small, there is a significant improvement in both resting pressures and patient continence scores. © The American Society of Colon and Rectal Surgeons.
AUTHOR KEYWORDS: Anorectal function; Extracorporeal magnetic stimulation
DOCUMENT TYPE: Article
SOURCE: Scopus

Quek, P.a b
A critical review on magnetic stimulation: What is its role in the management of pelvic floor disorders?
(2005) Current Opinion in Urology, 15 (4), pp. 231-235. Cited 4 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-20644453118&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Changi General Hospital, Singapore, Singapore;
Department of Urology, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore
ABSTRACT: Purpose of review: This review looks at the acute effects of magnetic stimulation on urodynamic parameters and reviews the data on its use in the management of urinary incontinence. Recent findings: Reported cure rates for stress incontinence immediately after a course of perineal magnetic stimulation range from 12.5 to 52.9% with good improvement occurring in 32% to 41%. However the effect seems temporary and dependent on the number of sessions. Sacral and pelvic floor magnetic stimulation have also been shown to increase cystometric capacity, inhibit detrusor overactivity and resolve overactive bladder symptoms acutely. Persistence of this effect with symptomatic improvement one week after sacral magnetic stimulation has been demonstrated. How magnetic stimulation suppresses detrusor contraction is not known. Prospective trials with the Neocontrol chair (Neotonus Inc, Marietta, Georgia, USA) also showed symptomatic improvement in 71 to 87% in the short term. However, the longer term data appear mixed. Summary: Overall, the data available vary too much in terms of treatment protocols, patient mix and symptom severity to determine which group of patients might benefit most and what the optimal stimulation parameters are for each condition. Mean reductions in leak parameters, although statistically significant, may not always be clinically satisfactory. The beneficial effects also appear to be temporary and continuous treatment will probably be required. Further trials are needed to determine the optimum stimulation protocols for different situations and to compare magnetic stimulation with other forms of conservative pelvic floor therapy. © 2005 Lippincott Williams & Wilkins.
AUTHOR KEYWORDS: Magnetic stimulation; Pelvic floor; Urinary incontinence
DOCUMENT TYPE: Review
SOURCE: Scopus

Kim, J.W., Kim, M.J., Noh, J.Y., Lee, H.Y., Han, S.W.
Extracorporeal pelvic floor magnetic stimulation in children with voiding dysfunction
(2005) BJU International, 95 (9), pp. 1310-1313. Cited 4 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-20444403419&partnerID=40&rel=R8.0.0
AFFILIATIONS: Brain Korea 21 Project for Medical Science, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
ABSTRACT: OBJECTIVE: To determine the effect of extracorporeal pelvic floor magnetic stimulation in children with an overactive bladder, as although such stimulation is an effective treatment for voiding dysfunction such as urge incontinence (UI) and urgency-frequency syndrome, experience in children is scarce. PATIENTS AND METHODS: This prospective study included 42 children diagnosed with an overactive bladder, based on urodynamic or video-urodynamic study; a complete follow-up was available in 34. The children were grouped into those with UI only, not monosymptomatic nocturnal enuresis (nMNE), or MNE, according to their symptoms. Clinical variables were assessed by recording a voiding and nocturnal enuresis diary before and after magnetic stimulation, the latter being administered twice a week for 4 weeks using a size-adjusted magnetic chair (each session took 20 min). RESULTS: The UI only and nMNE group had a significant decrease in voiding frequency and frequency of UI (P < 0.05); the MNE group also had a significant decrease in voiding frequency (P < 0.05). There was a significant increase in functional bladder capacity in all groups (P < 0.05) but no significant decrease in the mean volume and frequency of NE in the nMNE and MNE groups (P > 0.05). CONCLUSIONS: Extracorporeal pelvic floor magnetic stimulation has an acute effect on voiding dysfunction such as urge syndrome in children. However, controlled studies with a sham-stimulation group and various durations of stimulation are necessary for its application as a primary treatment for voiding dysfunction in children. © 2005 BJU INTERNATIONAL.
AUTHOR KEYWORDS: Child; Enuresis; Magnetic stimulation; Urinary incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

But, I.a d , Faganelj, M.b , Šoštarič, A.c
Functional magnetic stimulation for mixed urinary incontinence
(2005) Journal of Urology, 173 (5), pp. 1644-1646. Cited 2 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-17144425425&partnerID=40&rel=R8.0.0
AFFILIATIONS: Dept. Gen. Gynecol. Urogynecology, Maribor, Slovenia;
Maribor Teaching Hospital, Maribor, Slovenia;
Dept. of Elec. Eng. and Comp. Sci., University of Maribor, Maribor, Slovenia;
Dept. Gen. Gynecol. Urogynecology, Maribor Teaching Hospital, Ljubljanska 5, SI-2000 Maribor, Slovenia
ABSTRACT: Purpose: In this study we determined the efficacy of functional magnetic stimulation (FMS) compared to placebo for treating women with mixed urinary incontinence (MUI). Materials and Methods: A total of 39 women with MUI were randomly assigned to the FMS group (23 patients) or to the placebo group (16 patients). FMS was applied continuously at 18.5 Hz day and night for 2 months. Conventional urodynamic studies were performed before and after stimulation. Outcome measures assessed were clinical (daytime frequency, nocturia, pad use, pad weight) and urodynamic variables (first sensation of bladder filling, maximum cystometric capacity, maximum urethral closure pressure), and patient subjective assessment (visual analogue scale). Results: After 2 months of FMS significant decreases in voiding frequency (from 9.0 to 6.7, p = 0.0002), nocturia (from 2.6 to 1.4, p = 0.0007) and pad use (from 3.9 to 2.2, p = 0.007) were observed only in the FMS group. First sensation of bladder filling and maximum cystometric capacity increased significantly after stimulation compared with prestimulation levels only in the FMS group, p = 0.003 (from 118 to 174 ml) and p = 0.00004 (from 267 to 396 ml), respectively. A total of 18 women (78.3%) reported an improvement in symptoms after FMS with an average success rate of 41.9%. The success rate was significantly lower in the placebo group (p = 0.021) at 22.9%. Conclusions: Functional magnetic stimulation was useful and safe for treating women with MUI. Copyright © 2005 by American Urological Association.
AUTHOR KEYWORDS: Magnetics; Therapeutics; Urinary incontinence; Urodynamics
DOCUMENT TYPE: Article
SOURCE: Scopus

Yokoyama, T.a b , Inoue, M.a , Fujita, O.a , Nozaki, K.a , Nose, H.a , Kumon, H.a
Preliminary results of the effect of extracorporeal magnetic stimulation on urinary incontinence after radical prostatectomy: A pilot study
(2005) Urologia Internationalis, 74 (3), pp. 224-228. Cited 2 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-21244446960&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan;
Department of Urology, Okayama University Graduate School of Medical and Dentistry, 2-5-1 Shikata, Okayama 700-8558, Japan
ABSTRACT: Introduction: Radical prostatectomy is a common procedure for the treatment of clinically localized prostate cancer. However, urinary incontinence is a significant potential source of morbidity following surgery. Extracorporeal magnetic stimulation (ExMS) is a new technology used for pelvic muscle strengthening in the treatment of stress urinary incontinence. We investigated the clinical effects of ExMS on urinary incontinence after retropubic radical prostatectomy. Patients and Methods: Ten patients who had suffered from urinary incontinence for more than 12 months following radical prostatectomy were enrolled in this study. The Neocontrol system was used. Treatment sessions were for 20 min, twice a week for 2 months. The frequency of the pulse field was 10 Hz for 10 min, followed by a second treatment at 50 Hz for 10 min. Objective and subjective measures included voiding diaries, 1-hour pad weight testing, and a quality of life survey at 1, 2, 3, and 6 months after starting the treatment. Urodynamic studies were performed before and after treatment. Results: Three patients became dry (30%), 3 patients improved (30%), and 4 patients showed stationary symptoms (40%). In the 1-hour pad weight testing, the mean pad weight decreased from 25 to 10.3 g, and the quality of life scores had improved from 70.5 to 84.9 2 months after treatment. The frequency of leak episodes per day was reduced from 5.0 times before to 1.9 times after treatment. In the urodynamic study, mean maximum cystometric capacity and Valsalva leak point pressure increased from 197 ± 53.2 to 309 ± 85.3 ml and from 67.3 ± 22.6 to 97.1 ± 22.7 cm H2O after treatment, respectively (p < 0.05). 3 of 6 patients who showed improvement returned to the baseline values within 12 months after treatment and requested maintenance ExMS therapy. No side effects were observed. Conclusions: ExMS therapy offered a new option for urinary incontinence treatment after radical prostatectomy. Further studies are required to determine how long the benefits of treatment last and whether maintenance therapy is necessary. Copyright © 2005 S. Karger AG.
AUTHOR KEYWORDS: Extracorporeal magnetic stimulation, urinary incontinence; Radical prostatectomy; Urinary incontinence, extracorporeal magnetic stimulation
DOCUMENT TYPE: Article
SOURCE: Scopus

Odagaki, M., Suga, K., Sasaki, T., Hosaka, H.
Study on optimization for current distribution in magnetic stimulation therapy for urinary incontinence
(2004) Neurology and Clinical Neurophysiology, 2004, 5 p.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-29144474425&partnerID=40&rel=R8.0.0
AFFILIATIONS: Graduate School of Science and Engineering, Tokyo Denki University, Ishizaka, Oaza, Hatoyama-machi, Hiki-gun, Tokyo, Japan
ABSTRACT: It has been reported that magnetic stimulation effectively eliminates urinary incontinence. However, this type of therapy has not been established as a practical treatment for urinary incontinence because of its poor power conversion efficiency and the leakage of current to regions other than that of the target of stimulation. It is therefore necessary to develop magnetic stimulators that are more efficient in stimulating the sphincter muscles and the peripheral nerves, and are more convenient than those presently available. By using a large-diameter coil, the magnetic stimulation method offers a larger current distribution over a wider area of the target region than electrical stimulation method, and the placement of the coil can be relatively easily changed to obtain better therapeutic results. We attempted, with a computer simulation model of the female abdomen, to simulate the distribution of the induced current density on the basis of biological tissue conductivity. We determined which method of stimulation is the most efficient by varying the stimulator coil location and size. A genetic algorithm (GA) was used for optimization.
AUTHOR KEYWORDS: Finite element method; Genetic algorithm; Magnetic stimulation; Urinary incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

Yokoyama, T.a b , Fujita, O.a , Nishiguchi, J.a , Nozaki, K.a , Nose, H.a , Inoue, M.a , Ozawa, H.a , Kumon, H.a
Extracorporeal magnetic innervation treatment for urinary incontinence
(2004) International Journal of Urology, 11 (8), pp. 602-606. Cited 10 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-4344622115&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Okayama Univ. Grad. Sch. Med./Dent., Okayama, Japan;
Department of Urology, Okayama Univ. Grad. Sch. Med./Dent., 2-5-1 Shikata, Okayama 700-8558, Japan
ABSTRACT: Background: Extracorporeal magnetic innervation (ExMI) is a new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We explored whether this new technology is effective for patients with urge incontinence, as well as those with stress urinary incontinence. Methods: We studied 20 patients with urge incontinence and 17 patients with stress urinary incontinence. The Neocontrol system (Neotonus Inc., Marietta, GA) was used. Treatment sessions were for 20 min, twice a week for 8 weeks. Evaluations were performed by bladder diaries, one-hour pad weight testing, quality-of-life surveys and urodynamic studies. Results: Of the urge incontinence cases, five patients were cured (25.0%), 12 patients improved (60.0%) and three patients did not show any improvement (15.0%). Leak episodes per day reduced from 5.6 times to 1.9 times at 8 weeks (P < 0.05). Eight patients with urge incontinence recurred within 24 weeks after the last treatment (47.1%). Of the stress incontinence cases, nine patients were cured (52.9%), seven patients improved (41.1%) and one patient did not show any improvement (6%). In one-hour pad weight testing, the mean pad weight reduced from 7.9 g to 1.9 g at 8 weeks (P < 0.05). Three patients returned to the baseline values within 24 weeks after the last treatment (17.6%). No side-effects were experienced by any of the patients. Conclusion: Although the results for urge incontinence were less effective than for stress urinary incontinence, ExMI therapy offers a new option for urge incontinence as well as stress urinary incontinence.
AUTHOR KEYWORDS: Magnetic innervation; Urinary incontinence; Urodynamics
DOCUMENT TYPE: Article
SOURCE: Scopus

Gonçalves Almeida, F.b , Bruschini, H.a c , Srougi, M.b
Urodynamic and clinical evaluation of 91 female patients with urinary incontinence treated with perineal magnetic stimulation: 1-Year followup
(2004) Journal of Urology, 171 (4), pp. 1571-1574. Cited 8 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-18844473992&partnerID=40&rel=R8.0.0
AFFILIATIONS: Neurourology and Female Urol. Dept., Fed. Univ. of Sao Paulo-UNIFESP/EPM, São Paulo, Brazil;
Urology Department, Fed. Univ. of Sao Paulo-UNIFESP/EPM, São Paulo, Brazil;
Rua Horacio Lafer, 265, CEP 04538-081, Itaim, Sao Paulo-SP, Brazil
ABSTRACT: Purpose: We evaluate the perineal magnetic stimulation (PMS) effect on continence and quality of life in women with urinary incontinence. Materials and Methods: We prospective studied 91 women with demonstrable urinary incontinence treated with 16 sessions of PMS. Pretreatment and posttreatment evaluation was done by clinical history, physical examination, voiding diary, validated quality of life survey (I-QOL) and urodynamic study (UDS). Patients with no leakage after treatment were evaluated at 3, 6 and 12 months. Results: Mean patient age ± SD was 60.5 ± 10.1 years. Immediately after treatment the I-QOL score increased 35% (p <0.001), the number of pads daily decreased 40% (p <0.001), the number of leaks daily decreased 54% (p <0.001) and 34 patients (37%) became dry. Of the 91 patients 41 were evaluated before and after treatment by UDS. The average increase in vesical leak point pressure (VLPP) was 24.3% (p = 0.001) and initial VLPP in patients who became dry was greater than 80 cm H2O. After treatment 77% of patients with initial low pressure detrusor overactivity on UDS became free of this condition. One year after discontinuing PMS 94% of patients who became dry immediately after treatment had recurrence. Conclusions: Immediately after 16 sessions of PMS women with urinary incontinence have significant improvement in the I-QOL score with decreased daily pad use and leakage episodes but 63% had failure. Therapy is more effective in patients with a VLPP of greater than 80 cm H2O. The beneficial effect is temporary with high and early recurrence after discontinuing treatment.
AUTHOR KEYWORDS: Bladder; Magnetics; Quality of life; Urinary incontinence; Urodynamics
DOCUMENT TYPE: Article
SOURCE: Scopus

Dmochowski, R.a , Bukkapatnam, R.b , Raz, S.c , Tanagho, E.d
Urodynamic and clinical evaluation of 91 female patients with urinary incontinence treated with perineal magnetic stimulation: 1-Year followup. Editorial comments
(2004) Journal of Urology, 171 (4), pp. 1574-1575.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-1642287605&partnerID=40&rel=R8.0.0
AFFILIATIONS: Vanderbilt Continence Center, Department of Urology, Vanderbilt University Medical Center, Nashville, TN, United States;
Univ. of S. Florida Urology Program, University of South Florida, Brandon, FL, United States;
Urology Department, Univ. of California-San Francisco, San Francisco, CA, United States
DOCUMENT TYPE: Note
SOURCE: Scopus

Chandi, D.D.a b , Groenendijk, P.M.a , Venema, P.L.a
Functional extracorporeal magnetic stimulation as a treatment for female urinary incontinence: 'The chair'
(2004) BJU International, 93 (4), pp. 539-542. Cited 8 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-1642377814&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Leyenburg Hospital, The Hague, Netherlands;
Roodmus 5, 3435 CG Nieuwegein, Netherlands
ABSTRACT: OBJECTIVE: To evaluate, in a prospective study, the efficiency and applicability of functional magnetic stimulation (FMS) of the pelvic floor for treating urinary incontinence in women. PATIENTS AND METHODS: FMS was provided by a 'magnetic chair'; 24 patients were treated twice weekly for 8 weeks (12 with urge incontinence and 12 with a mixture of urge and stress incontinence). The outcome was assessed urodynamically, by a pad test, and by patient satisfaction. RESULTS: In 58% of the patients there was an objective improvement in incontinence; three patients were completely dry and 71% reported a subjective improvement (P < 0.001). CONCLUSION: FMS is a safe, noninvasive and painless treatment for urinary incontinence; it is effective and easy to administer as an outpatient treatment.
AUTHOR KEYWORDS: Electrical; Functional magnetic stimulation; Stress incontinence; Urge
DOCUMENT TYPE: Article
SOURCE: Scopus

Yokoyama, T.a b , Nishiguchi, J.a , Watanabe, T.a , Nose, H.a , Nozaki, K.a , Fujita, O.a , Inoue, M.a , Kumon, H.a
Comparative study of effects of extracorporeal magnetic innervation versus electrical stimulation for urinary incontinence after radical prostatectomy
(2004) Urology, 63 (2), pp. 264-267. Cited 7 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-1242341929&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Okayama University, Grad. Sch. of Medicine and Dentistry, Okayama, Japan;
Department of Urology, Okayama University, Grad. Sch. of Medicine and Dentistry, 2-5-1 Shikata, Okayama 700-8558, Japan
ABSTRACT: Objectives. To perform a randomized comparative study to investigate the clinical effects of extracorporeal magnetic innervation (ExMI) and functional electrical stimulation (FES) on urinary incontinence after retropubic radical prostatectomy. Methods. Thirty-six patients with urinary incontinence after radical prostatectomy were randomly assigned to three groups (12 patients each in the FES, ExMI, and control groups). For FES, an anal electrode was used. Pulses of 20-Hz square waves at a 300-μs pulse duration were used for 15 minutes twice daily for 1 month. For ExMI, the Neocontrol system was used. The treatment sessions were for 20 minutes, twice a week for 2 months. The frequency of the pulse field was 10 Hz for 10 minutes, followed by a second treatment at 50 Hz for 10 minutes. For the control group, only pelvic floor muscle exercises were performed. Objective measures included bladder diaries, 24-hour pad weight testing, and a quality-of-life survey, at 1, 2, and 4 weeks and 2, 3, 4, 5, and 6 months after removing the catheter. Results. The leakage weight during the 24 hours after removing the catheter was 684, 698, and 664 g for the FES, ExMI, and control groups, respectively. At 1 month, it was 72, 83, and 175 g (FES versus control, P <0.05) and at 2 months was 54, 18, and 92 g (ExMI versus control, P <0.05) in the FES, ExMI, and control groups, respectively. Finally, 6 months later, the average 24-hour leakage weight was less than 10 g in all groups. Quality-of-life measures decreased after surgery, but gradually improved over time in all groups. No complications were noted in any of the groups. Conclusions . ExMI and FES therapies offered earlier continence compared with the control group after radical prostatectomy. We consider ExMI and FES to be recommendable options for patients who want quick improvement of postoperative urinary incontinence. © 2004 Elsevier Inc.
DOCUMENT TYPE: Article
SOURCE: Scopus

Ünsal, A.a b , Saglam, R.a , Cimentepe, E.a
Extracorporeal Magnetic Stimulation for the Treatment of Stress and Urge Incontinence in Women: Results of 1-year Follow-up
(2003) Scandinavian Journal of Urology and Nephrology, 37 (5), pp. 424-428. Cited 6 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0344441821&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, School of Medicine, Fatih University, Ankara, Turkey;
Department of Urology, School of Medicine, Fatih University, Ciftlik Cd. No: 57, TR-06510 Emek, Ankara, Turkey
ABSTRACT: Objective: To evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress and urge urinary incontinence in women. Material and Methods: A total of 35 patients with stress incontinence and 17 with urge incontinence were enrolled in this study. All patients were evaluated by means of a detailed history of incontinence, a gynecologic examination, urine culture, urinary system ultrasound and a urodynamic study. All patients were asked to keep a 3-day voiding diary. A pad-weighing test was done for each patient at their first visit. For treatment, the patients were seated on a special chair containing a magnetic field generator. Pelvic floor muscle stimulation was performed for 20 min (10 min at 5 Hz and 10 min at 50 Hz) twice a week for a total of 8 weeks. The mean follow-up period was 16.8 months (range 12-32 months). A total of 44 patients completed 1 year of follow-up and were re-evaluated by means of voiding diary, pad-weighing test and cystometric study. Results: Of the 44 patients, 11 (38%) with stress incontinence and 6 (40%) with urge incontinence were cured 1 year after the treatment. In addition, there was an improvement in symptoms in 12 patients (41%) in the stress group and 7 (47%) in the urge group. Pad weight was reduced from 15.4 to 5.8 g in the stress group and from 12.4 to 4.7 g in the urge group (p = 0.000 and 0.001, respectively). Mean Valsalva leak point pressure was increased from 87.3 ± 15.9 to 118.0 ± 11.0 cmH2O in the stress group (p = 0.000). Conclusions: Extracorporeal magnetic stimulation therapy offers a non-invasive, effective and painless treatment for stress and urge incontinence in women.
AUTHOR KEYWORDS: Frequency; Magnetic stimulation; Stress incontinence; Urge incontinence; Urgency
DOCUMENT TYPE: Article
SOURCE: Scopus

Takahashi, S.a b , Kitamura, T.a
Overactive bladder: Magnetic versus electrical stimulation
(2003) Current Opinion in Obstetrics and Gynecology, 15 (5), pp. 429-433. Cited 4 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0142216268&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Faculty of Medicine, Tokyo University, Tokyo, Japan;
Department of Urology, Faculty of Medicine, Tokyo University, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
ABSTRACT: Purpose of review: To review recent literature on the electrical and magnetic stimulation of the sacral nerve roots and pelvic floor for the treatment of overactive bladder. Recent findings: Overactive bladder is a common condition affecting millions of women worldwide, with a significant effect on quality of life. Electrical stimulation and neuromodulation of the sacral nerve roots have provided a useful alternative for these patients with satisfactory outcomes. The use of the procedures has been limited, however, mainly due to local discomfort/pain or invasiveness of the surgical procedure. Magnetic stimulation can activate deep neural structures by induced electric currents noninvasively. Recent investigations demonstrated that magnetic stimulation of the sacral roots suppressed detrusor overactivity more effectively compared with electrical stimulation. Clinical trials including randomized placebo-controlled studies demonstrated the excellent short-term effect of magnetic stimulation in the treatment of overactive bladder. Summary: Magnetic stimulation appears to induce inhibitory effects on detrusor overactivity in a similar manner to electrical stimulation, with significant clinical advantages. Although further studies are needed to establish long-term efficacy, magnetic stimulation of the sacral nerve roots may be a promising alternative treatment for overactive bladder.
AUTHOR KEYWORDS: Electrical stimulation; Magnetic stimulation; Neuromudulation; Overactive bladder; Pelvic floor; Sacral nerve; Urge incontinence; Urinary frequency
DOCUMENT TYPE: Review
SOURCE: Scopus

Kirschner-Hermanns, R., Jakse, G.
Magnet stimulation therapy: A simple solution for the treatment of stress and urge incontinence? [Magnetstimulationstherapie: Eine einfache lösung fü die behadlung der stress- und dranginkontinenz?]
(2003) Urologe - Ausgabe A, 42 (6), pp. 819-822. Cited 1 time.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0037594412&partnerID=40&rel=R8.0.0
AFFILIATIONS: Urologische Klinik, Universitätsklinikum, Pauwelsstraße 30, 52057 Aachen, Germany
ABSTRACT: Aim. Magnet stimulation therapy has been offered as a new, conservative therapy for stress and urge incontinence in Germany since 2001. Focussed, pulsating magnetic fields are used to stimulate the musculature of the floor of the pelvis. This publication describes our initial experience with this method. Patients and methods. We treated 27 patients with magnetic stimulation. The individual patient sits clothed on a therapy-chair and is treated for 20 min twice a week for 2 weeks. Results. The best results were recorded in female patients with grades I and II stress incontinence who could not actively flex their pelvic-floor musculature during physiotherapy. A marked reduction in the frequency of micturition was obtained in 67% of patients with urge incontinence symptoms and non-responsiveness to anticholinergic therapy. Patients with a nonorganically tangible pelvic-pain-syndrome did not benefit from the therapy. Conclusions. Magnet stimulation therapy can act as a useful addition to conservative therapies for stress and urge incontinence. It is free of complications and does not involve the insertion of an electrode into the patient as is the case for vaginal and anal electrostimulation. However, this method does not appear to be useful for chronic, non-specific pain in the lower pelvis.
AUTHOR KEYWORDS: Conservative therapy; Electrostimulation; Pelvic pain syndrome; Stress incontinence; Urge incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

But, I.a b
Conservative treatment of female urinary incontinence with functional magnetic stimulation
(2003) Urology, 61 (3), pp. 558-561. Cited 10 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0037334628&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Gynecology, Maribor Teaching Hospital, Maribor, Slovenia;
Department of Gynecology, Maribor Teaching Hospital, Ljubljanska 5, Maribor 2000, Slovenia
ABSTRACT: Objectives. To determine the efficacy and safety of functional magnetic stimulation (FMS) produced by the Pulsegen device compared with placebo in the treatment of women with urinary incontinence. Methods. Fifty-five women with urinary incontinence were randomly assigned to the active FMS group (30 patients) or the placebo group (22 patients). Each patient in the active group received a Pulsegen device, which produced a pulsating magnetic field of B = 10 μT intensity and a frequency of 10 Hz. Patients were asked to wear the Pulsegen device day and night for 2 months. Clinical and urodynamic data were collected before and after FMS and analyzed using nonparametric statistics. Results. Compared with the placebo, the number of pads used was significantly lower (P = 0.0031) after FMS, as was the pad weight (P = 0.014). In patients from the active group, a significant improvement in the power of the pelvic floor muscle contractions (P = 0.0071), as well as in the duration of the pelvic floor muscle contractions (P = 0.038), was observed. After FMS, a 56.3% improvement in urinary incontinence symptoms was reported by patients in the active group, a significantly greater difference (P = 0.00012) compared with the reported 26.3% improvement in symptoms in the placebo group. Conclusions. We believe that FMS represents a new method in the conservative treatment of urinary incontinence. Magnetic stimulation with the Pulsegen device is efficient and safe. It can be used at home and, because of its small size, wearing the device is not annoying for patients. © 2003, Elsevier Science Inc.
DOCUMENT TYPE: Article
SOURCE: Scopus

Fujishiro, T., Takahashi, S., Enomoto, H., Ugawa, Y., Ueno, S., Kitamura, T.
Magnetic stimulation of the sacral roots for the treatment of urinary frequency and urge incontinence: An investigational study and placebo controlled trial
(2002) Journal of Urology, 168 (3), pp. 1036-1039. Cited 16 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0036719976&partnerID=40&rel=R8.0.0
AFFILIATIONS: Departments of Urology and Neurology, Institute of Medical Electronics, University of Tokyo, Tokyo, Japan
ABSTRACT: Purpose: We designed an investigational study and placebo controlled trial to evaluate the efficacy of magnetic stimulation of the sacral roots for treating urinary frequency and urge incontinence. Materials and Methods: A total of 48 women 43 to 75 years old (mean age 61) with the complaint of urinary frequency and/or urge incontinence were studied. We applied 15 Hz. repetitive magnetic stimulation of the sacral roots with 50% intensity output for 5 seconds per minute for 30 minutes. Urodynamic investigations during magnetic stimulation were performed in 11 cases to evaluate acute effects for lowering urinary tract function. Another 37 women were enrolled in a placebo controlled study to investigate short-term effects. The mean number of voids daily, mean urine volume per void, number of leaks for 3 days and quality of life score were evaluated before and 1 week after stimulation. Results: Urodynamic investigations revealed apparent elevation in mean maximum urethral closure pressure plus or minus standard deviation during stimulation in all 11 cases (8.4 ± 3.6 cm. water, p = 0.00001) and a significant increase in mean bladder capacity after stimulation (58.2 ± 50.2 ml., p = 0.003). In the placebo controlled study all parameters significantly improved in the active stimulation group. Intergroup comparison showed that mean urine volume per void, mean number of leaks and mean quality of life score improved more significantly in the active than in the sham stimulation group (23.5 ± 25.6 ml. versus 6.2 ± 22.5, p = 0.04, 3.6 ± 4.1 versus 0.4 ± 1.4, p = 0.04 and 1.4 ± 1.3 versus 0.4 ± 0.8, p = 0.01, respectively). No adverse effects were noted in any patients. Conclusions: These results suggest that magnetic stimulation of the sacral roots may be useful for treating urinary frequency and urge incontinence.
AUTHOR KEYWORDS: Bladder; Electric stimulation therapy; Magnetics; Spine nerve roots; Urinary incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

Goldberg, R.P.b d , Sand, P.K.a c
Electromagnetic pelvic floor stimulation: Applications for the gynecologist
(2000) Obstetrical and Gynecological Survey, 55 (11), pp. 715-720. Cited 2 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0033764284&partnerID=40&rel=R8.0.0
AFFILIATIONS: Evanston Continence Center, Northwestern University Medical School, Evanston Northwestern Healthcare, Evanston, IL, United States;
Division of Urogynecology and Reconstructive Pelvic Surgery, Northwestern University Medical School, Evanston Northwestern Healthcare, Evanston, IL, United States;
Department of Obstetrics and Gynecology, Northwestern University Medical School, Evanston Northwestern Healthcare, Evanston, IL, United States;
1000 Central Street, Evanston, IL 60201, United States
ABSTRACT: The therapeutic potential of magnetic energy has been a subject of long-standing interest within both conventional and alternative medical practice. Numerous devices using magnetic fields, ranging from the dubious to truly innovative, have claimed a wide variety of clinical benefits. For gynecologists involved with the diagnosis and treatment of pelvic floor and bladder dysfunction, magnetic stimulation of the sacral nerve roots and peripheral nerves continues to evolve as a noninvasive treatment alternative. The conduction characteristics of magnetic energy confer several practical advantages for its use. This article reviews the use of electromagnetic stimulation for treatment of common urogynecologic conditions, and provides an historical overview of the therapeutic application of electromagnetic energy. Target Audience: Obstetrics and Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to describe the mechanism by which electromagnetic stimulation can be used to treat various conditions, to list the various gynecologic conditions that are amenable to therapy with electromagnetic stimulation, and to compare electromagnetic stimulation and electrical stimulation.
DOCUMENT TYPE: Review
SOURCE: Scopus

Yamanishi, T.a , Sakakibara, R.b , Uchiyama, T.b , Suda, S.c , Hattori, T.b , Ito, H.a , Yasuda, K.c d
Comparative study of the effects of magnetic versus electrical stimulation on inhibition of detrusor overactivity
(2000) Urology, 56 (5), pp. 777-781. Cited 24 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0033783143&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, Chiba University School of Medicine, Chiba, Japan;
Department of Neurology, Chiba University School of Medicine, Chiba, Japan;
Department of Urology, Dokkyo University School of Medicine, Koshigaya Hospital, Saitama, Japan;
Department of Urology, Dokkyo University, Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama 343, Japan
ABSTRACT: Objectives. To perform a randomized comparative study investigating the urodynamic effects of functional magnetic stimulation (FMS) and functional electrical stimulation (FES) on the inhibition of detrusor overactivity.Methods. Thirty-two patients with urinary incontinence due to detrusor overactivity (15 men, 17 women; age 62.3 ± 16.6 years) were randomly assigned to two treatment groups (15 patients in the FMS group and 17 in the FES group). Stimulation was applied continuously at 10 Hz in both groups. For FMS, the magnetic stimulator unit was set on an armchair type seat and had a concave-shaped coil, so that the patients could sit during stimulation. For FES, a vaginal electrode was used in the women and a surface electrode on the dorsal part of the penis was used in the men. Cystometry was performed before and during the stimulation.Results. The bladder capacity at the first desire to void and the maximum cystometric capacity increased significantly during stimulation compared with prestimulation levels in both groups (P = 0.0054 and 0.0026, respectively, in the FMS group and P = 0.0015 and 0.0229, respectively, in the FES group). However, the increase in the maximum cystometric capacity was significantly (P = 0.0135) greater in the FMS group (114.2 ± 124.1 mL or an increase of 105.5% ± 130.4% compared with the pretreatment level) than that in the FES group (32.3 ± 56.6 mL or an increase of 16.3% ± 33.9%). Detrusor overactivity was abolished in 3 patients in the FMS group but not in any patient in the FES group.Conclusions. Although both treatments were effective, the inhibition of detrusor overactivity appeared greater in the FMS group than in the FES group. Copyright (C) 2000 Elsevier Science Inc.
DOCUMENT TYPE: Article
SOURCE: Scopus

Fujishiro, T., Enomoto, H., Ugawa, Y., Takahashi, S., Ueno, S., Kitamura, T.
Magnetic stimulation of the sacral roots for the treatment of stress incontinence: An investigational study and placebo controlled trial
(2000) Journal of Urology, 164 (4), pp. 1277-1279. Cited 15 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0033813339&partnerID=40&rel=R8.0.0
AFFILIATIONS: Sanraku Hospital, Institute of Medical Electronics, University of Tokyo, Tokyo, Japan
ABSTRACT: Purpose: We designed an investigational study and placebo controlled trial to evaluate the potential efficacy of magnetic stimulation of the sacral roots for the treatment of stress incontinence. Materials and Methods: A total of 75 patients with stress incontinence were studied. A 15 Hz. repetitive magnetic stimulation of the sacral roots with 50% intensity output and duration of 5 seconds per minute was applied for 30 minutes. Urodynamic investigations under magnetic stimulation were performed in 13 patients to evaluate acute effects to lower urinary tract function. There were 62 women (mean age 58 years) enrolled in a placebo controlled study to investigate the short-term efficacy of magnetic stimulation. The number of leaks for 3 days, amount of urine loss on a pad test and quality of life score were evaluated before and 1 week after stimulation. Results: The urodynamic investigations revealed an apparent elevation of urethral closure pressure induced by stimulation (mean 8.2 ± 3.0 cm H2O, p = 0.0000004) and a significant increase in bladder capacity after stimulation (mean 40.0 ± 51.0 ml., p = 0.0152). In the placebo controlled study the number of leaks and amount of urine loss on a pad test significantly decreased more in the active than in the sham stimulation group (p = 0.0023 and 0.0377, respectively). The quality of life score significantly improved in the active stimulation group (p = 0.0006) in contrast to no significant improvement in the sham stimulation group. The improvement rate in the active stimulation group was 74%, which was significantly higher than the 32% in the sham stimulation group (p = 0.0009). No adverse effects were noted in any patients. Conclusions: These results suggest that magnetic stimulation of the sacral roots may be useful for the treatment of stress incontinence. Further studies are needed to evaluate the long-term efficacy of this potential treatment.
AUTHOR KEYWORDS: Case-control studies; Magnetics; Sacrum; Stress; Urinary incontinence
DOCUMENT TYPE: Article
SOURCE: Scopus

Carlan, S.J., Russell, H., Shelnutt, J., Peppy, T., Griggs, B.
Extracorporeal magnetic innervation (EXMI) therapy in the treatment of urinary incontinence in women: Results from a single center [1]
(2000) Journal of the American Geriatrics Society, 48 (4), p. 456. Cited 1 time.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0034125683&partnerID=40&rel=R8.0.0
AFFILIATIONS: Dept. of Obstetrics and Gynecology, A. Palmer Hosp. for Children/Women, Orlando, FL, United States
DOCUMENT TYPE: Letter
SOURCE: Scopus

Yamanishi, T., Yasuda, K., Suda, S., Ishikawa, N., Sakakibara, R., Hattori, T.
Effect of functional continuous magnetic stimulation for urinary incontinence
(2000) Journal of Urology, 163 (2), pp. 456-459. Cited 29 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0033957907&partnerID=40&rel=R8.0.0
ABSTRACT: Purpose: We evaluated the therapeutic efficacy of continuous magnetic stimulation on urinary incontinence by studying the urodynamic effect on urethral closure and bladder inhibition. Materials and Methods: A total of 11 patients with stress incontinence and 12 with urge incontinence (7 males and 16 females, mean age 55.8 years) were evaluated. In the pilot study urethral pressure profile was performed before and after 20 Hz. 15-minute (with 1- minute on/30-second off cycles) stimulation, and maximum intraurethral pressure was recorded during stimulation in stress incontinence cases. Cystometry was performed before and during 15-minute stimulation at 10 Hz. in urge incontinence cases. In the therapeutic study 8 females with stress incontinence, and 3 males and 5 females with urge incontinence were treated with magnetic stimulation twice a week for 5 weeks. Results: In the pilot study maximum intraurethral pressure increased by 34% during stimulation and maximum urethral closure pressure increased by 20.9% (p = 0.0409) after stimulation in stress incontinence cases. In urge incontinence cases significant increases in bladder capacities at first and maximum desire to void during stimulation were noted (p = 0.0164 and 0.0208, respectively). In the therapeutic study 86% of 7 patients with stress incontinence and 75% of 8 with urge incontinence were improved, and i dropped out of the study. Conclusions: Continuous magnetic stimulation was effective on urethral closure and bladder inhibition, and as treatment of urinary incontinence.
AUTHOR KEYWORDS: Electric stimulation; Magnetics; Urinary incontinence; Urodynamics
DOCUMENT TYPE: Article
SOURCE: Scopus

Gunnarsson, M.a c , Ahlmann, S.b , Lindström, S.b , Rosén, I.b , Mattiasson, A.a
Cortical magnetic stimulation in patients with genuine stress incontinence: Correlation with results of pelvic floor exercises
(1999) Neurourology and Urodynamics, 18 (5), pp. 437-445. Cited 8 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0032834268&partnerID=40&rel=R8.0.0
AFFILIATIONS: Department of Urology, University Hospital, Lund, Sweden;
Dept. of Clinical Neurophysiology, University Hospital, Lund, Sweden;
Department of Urology, University Hospital, S-221 85 Lund, Sweden
ABSTRACT: Pelvic floor training is an established conservative method of treatment in patients with genuine stress incontinence. It is not known why only a proportion of patients benefit from this form of treatment, while others with a comparable degree of incontinence do not. Since muscle awareness is of vital importance in pelvic floor training, we decided to investigate whether differences in outcome might be explained by differences in cortical control of the pelvic floor muscles. The function in the total motor pathway to the pelvic floor muscles was examined with cortical magnetic stimulation and circumvaginal EMG recording. Since lesions of the peripheral motor pathway have been demonstrated in patients with genuine stress incontinence, possible differences at this level were investigated by means of terminal pudendal motor latencies, using electrical nerve stimulation and anal recording EMG. We found that patients who succeeded with pelvic floor exercises for genuine stress incontinence had a significantly higher probability of response to cortical magnetic stimulation and significantly larger response amplitudes than the patients who did not benefit from training. The findings in the latter group did not differ from those of a healthy control group. No differences between the groups were found in the terminal pudendal motor latencies. We conclude that women with genuine stress urinary incontinence, successfully alleviated by a physiotherapeutic training program, have a higher degree of corticofugal control of their perineal muscles than women who do not succeed with the same treatment program and healthy controls.
AUTHOR KEYWORDS: Evoked response; Magnetic stimulation; Pelvic floor
DOCUMENT TYPE: Article
SOURCE: Scopus

Galloway, N.T.M., El-Galley, R.E.S., Sand, P.K., Appell, R.A., Russell, H.W., Carlan, S.J.
Extracorporeal magnetic innervation therapy for stress urinary incontinence
(1999) Urology, 53 (6), pp. 1108-1111. Cited 49 times.
http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0033152664&partnerID=40&rel=R8.0.0
AFFILIATIONS: Emory Continence Center, 3903 South Cobb Drive, Atlanta, GA 30080, United States
ABSTRACT: Objectives. To report the first data from a prospective clinical study to determine the feasibility of using extracorporeal magnetic innervation (ExMI) for the treatment of stress urinary incontinence. Methods. We studied 83 women with demonstrable stress urinary incontinence. Treatments were for 20 minutes, twice a week for 6 weeks. For treatment, the patient sits fully clothed on a special chair; within the seat is a magnetic field generator that produces the rapidly changing magnetic field flux. Objective measures included bladder diaries, dynamic pad weight testing, urodynamic studies, and quality of life survey. Results. Fifty patients have been followed up for longer than 3 months (33 patients for less than 3 months); 17 patients (34%) were dry, 16 (32%) were using not more than 1 pad per day, and 17 (34%) were using more than 1 pad per day. Pad use was reduced from 2.5 to 1.3 (P = 0.001) and leak episodes per day were reduced from 3.3 to 1.7 (P = 0.001). The pad weight was reduced from 20 to 15 g. Detrusor instability was found in 5 patients before but was demonstrated in only 1 patient after treatment. Conclusions. ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI is painless, there is no need for a probe, and no need to undress for treatments. Longer follow-up is required to determine how long the benefits of treatment last and whether retreatment will be necessary.
DOCUMENT TYPE: Article
SOURCE: Scopus

6 May 08

Robotic Assisted Laparoscopic Prostatectomy

Quality of Life Benefits for Robotic Prostatectomy

It is well established that standard laparoscopy has benefits over open surgery. These advantages include reduced post-operative pain and analgesia requirements, shorter hospital stay and faster return to work and normal activities.

The daVInci robot is a significant technological advance on standard laparoscopy, which allows more complex surgery to be performed more efficiently. There are three main advances. Firstly, the surgeon console reconstructs the surgical field in three dimensions. This replicates the “feel’ of open surgery, and avoids the 2D images of standard laparoscopy. The robot also magnifies the surgical field by up to a factor of 10. This enhances the precision of the operation, with improved haemostasis and less blood loss, and increased ability to preserve important structures such as the neurovascular bundle. Lastly, the EndoWrist instruments effectively mimic the movements of the human hand. This allows the surgeon to perform complex movements not previously attainable by conventional laparoscopy.

This report summarizes the medical literature of quality of life benefits of robotic radical prostatectomy. There is good evidence that robotic prostatectomy has advantages over conventional open surgery with regard to hospital stay, return to normal activity, early return of continence and potency.

Hospital Stay

In a study by Badani et al of over 2,700 patients, 96.7% of men undergoing a robotic prostatectomy were discharged within 24 hours of surgery. Post-operative narcotic analgesia requirements were also significantly less. In comparison, discharge within 48 hours of an open radical prostatectomy is extremely unusual; less than 5% of patients would be discharged within that timeframe.

Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Badani KK, Kaul S, Menon M. Cancer. 2007 Nov 1;110(9):1951-8

Return to Normal Activity

There is good evidence to suggest that robotic prostatectomy facilitates a faster return to normal activities. Miller et al, in their well designed study, found that there were significant advantages for those in the robotic group when compared to the open radical prostatectomy group; the robotic group were less restricted in activities as early as the first week, and this advantage persisted for 6 weeks.

Prospective evaluation of short-term impact and recovery of health related quality of life in men undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy. Miller J, Smith A, Kouba E, Wallen E, Pruthi RS. J Urol. 2007 Sep;178(3 Pt 1):854-8; discussion 859

Early Return of Continence

While standard open radical prostatectomy has very low incontinence rates (approx 5%), there can be a delay of 6-12 months after surgery to achieve continence. Patel et al have published results that suggest that robotic prostatectomy may confer an advantage with earlier return to continence; 89% of men were continent at 3 months.

Robotic radical prostatectomy: outcomes of 500 cases. Patel VR, Thaly R, Shah K.
BJU Int. 2007 May;99(5):1109-12.

Potency

The magnified optics, 3D reconstruction and the capabilities of the robotic instruments allows very precise pelvic dissection; this is very important if the neurovascular bundle is to be preserved in order to maintain the patient’s potency. A study by Menon et al showed that 93% of men were potent after robotic prostatectomy; this is at least equal to the very best results achieved by open radical prostatectomy.

Vattikuti Institute prostatectomy: contemporary technique and analysis of results. Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M, Peabody JO. Eur Urol. 2007 Mar;51(3):648-57; discussion 657-8.

Compiled by Liam Wilson FRACS, Urologist

30 Apr 08

Cryotherapy treatment now available in Australasia for the first time

Cryosurgery involves the freezing of tissue and tumours and has been used in various forms in urology over the last 15 years. Third generation machines have recently become available which significantly improve the accuracy and overall treatment results compared to older generation devices. As of December 2004 we are able to offer cryotherapy for selected patients who have both prostate cancer and renal (kidney) cancer. The patients who are ideal for this sort of treatment are generally patients who have had radiation treatment to the prostate which has failed to control the tumour and in whom no other signs of cancer in the body have been found. The ideal kidney tumours are small tumours which have typically been found on investigations for other problems but will ultimately grow to a significant size and become life threatening. There is also a place which is being investigated for the use of this technology for the initial treatment of prostate cancer rather than undergoing surgery or radiation.

The new third generation machine and technique which we have acquired involves the use of fine probes through which pressurised gas can freeze and thaw the tissue. Argon gas is used for the freezing and Helium gas is used for the thawing. This is generally done twice to the entire prostate or kidney tumour. For the prostate treatments some fine cryo needles are placed very precisely through the skin in the perineum using ultrasound control. Once these have been accurately placed under general anaesthetic the ice balls are created. There are thermo-sensors inside and outside the prostate which confirm that the tissue has been frozen and that the surrounding tissue has not been excessively treated. A warming catheter is placed in the urethra to prevent damage in this area. Two freeze-thaw cycles are typically used which results in complete eradication of the tumour in properly selected cases. Generally patients are able to go home the following day which is a significant improvement on earlier devices.

- Peter Gilling

30 Apr 08

Brachytherapy

One of the treatments for early prostate cancer is the use of radiotherapy. This can be delivered externally, which is known as External Beam Radiotherapy and generally takes 6 weeks and can be associated with quite a few side effects.

A more efficient alternative is the use of radioactive seeds implanted in the prostate known as Brachytherapy. The seeds are made of titanium and contain radioactive iodine. These seeds gradually lose their radioactivity over a period of time and can be placed in such a way as to create much higher doses of radiation to selected areas of the prostate with minimal effects on the tissues surrounding the prostate. This therefore reduces the risk of side effects.

Brachytherapy is best offered to men who have a PSA test under 15 and preferably under 10 who have intermediate grade cancer (Gleasonís Grade 3) or less. Brachytherapy involves two steps, the first being the volume study during which the prostate is scanned and electronic images taken. These are then down loaded into a computer program to plan the precise placement of the individual seeds. The second step takes place approximately 4 weeks later when the implant is carried out. Ultrasound scanning is used to accurately place the seeds which are inserted via needles through the perineum (the area behind the testicles and in front of the anus).

This is a minimally invasive procedure with an overnight hospital stay. Men are fit to go home the following day with no restrictions on activities. The main problem associated with brachytherapy is that the radiation causes the prostate to swell temporarily causing symptoms of poor flow, getting up at night, hesitation and in some cases complete (temporary) urinary blockage. Approximately 30% of men will have mild bowel disturbance after the procedure and about 15% of men will develop impotence which fortunately responds well to the use of various medical treatments. The cure rates for brachytherapy are similar to those for surgery but with the advantage of minimal side effects. The major drawback for brachytherapy is its cost which is in the order of $20,000 - $26,000 although this is covered by insurance companies. Brachytherapy is not available through the public hospital system.

- Mark Fraundorfer

15 Nov 04

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