Urinary incontinence in the aged is associated with lesions of the central nervous system. One often will see both continent and incontinent patients who have similar neurological deficits. Urodynamic studies show that in most cases the deficit is rostral to the pontine micturition center. It appears that the neurological pathways of sensory perception and motor control have been partially interrupted. Since the deficit in most cases apears to occur in the subcortical modulating centers of the central nervous system, a rational approach to therapy would focus on altering the facilitory-inhibitory balance of the subcortical centers. It is the hypothesis of this study that biofeedback therapy can modify the central nervous system control of urinary continence mechanisms to the extent that continence will result in many cases. Eighty male patients over 65 years of age will be selected for study based on the objective demonstration of involuntary loss of greater than 25 cc of urine on each of four separate 24 hour testing periods using a diaper exchange measurement every three hours with an electronic wet meter during the night to measure the frequency of nocturnal enuresis. Characterization of other patient parameters will be done using complete urodynamic testing, cortical function tests, psychiatric evaluation, neurological evaluation, complete social history, and cystoscopic exam. Since the amplitude and frequency of EMG activity coincide with a fall in urethral pressure and changes in EMG can be voluntarily controlled, patch electrode EMG with visual and auditory feedback are used by the nursing personnel for feedback training. Five training sessions will be given at one week, four weeks, and eight weeks after beginning the study. Response to theray will be measured at 12 weeks using a four day quantative measurement of urinary incontinence and complete urodynamic testing. The results after therapy will be compared with the pretreatment findings to determine the efficacy of this biofeedback technique. Significant improvement in incontinence and urodynamic parameters will be correlated with other patient parameters to determine selection criteria for the clinical use of this biofeedback therapeutic technique. Future studies will include combination therapy using pharmacotherapeutic agents with biofeedback therapy.
| O'Donnell, P D; Doyle, R (1991) Biofeedback therapy technique for treatment of urinary incontinence. Urology 37:432-6 |
| O'Donnell, P D; Calandro 2nd, V J (1991) Incontinence management scale for elderly inpatient men. Urology 37:220-3 |
| O'Donnell, P D; Beck, C (1991) Urinary incontinence volume patterns in elderly inpatient men. Urology 38:128-31 |
| O'Donnell, P D; Finkbeiner, A E; Beck, C (1990) Urinary incontinence volume measurement in elderly male inpatients. Urology 35:499-503 |
| O'Donnell, P D; Beck, C; Walls, R C (1990) Serial incontinence assessment in elderly inpatient men. J Rehabil Res Dev 27:1-8 |
| O'Donnell, P; Beck, C; Doyle, R et al. (1988) Surface electrodes in perineal electromyography. Urology 32:375-9 |
