New Therapy Helps Control Bladder Problems
BACKGROUND: Millions of people experience bladder control problems, including urinary urge incontinence, non-obstructive urinary retention, and significant symptoms of urgency-frequency. An innovative therapy for overactive bladder and urinary retention called sacral nerve stimulation (InterStim Therapy) is available for patients who have failed or could not tolerate more conservative treatments. The therapy provides urinary control therapy that addresses the nerve component of bladder control problems. Over 75,000 patients have received sacral nerve stimulation worldwide. The therapy is minimally invasive and begins with a simple in-office test. Sacral nerve stimulation is indicated for patients who suffer from urinary urge incontinence, urinary urgency-frequency, or non-obstructive urinary retention. (SOURCE: MedTronic)
PROCEDURE: Sacral nerve stimulation is conducted through an implanted device that includes a thin insulated wire called a lead and a neurostimulator (much like a cardiac pacemaker.) The device is inserted in a pocket in the patient’s lower abdomen. It sends mild electrical impulses through a lead that is positioned close to a nerve located in the lower back (the sacral nerve), which influences the bladder, the sphincter and the pelvic floor muscles. Sacral nerve stimulation is first tried on an outpatient basis in the doctor’s office with the implantation of a test lead. If the trial treatment is successful, the patient is scheduled for inpatient surgery. Permanent surgical implantation is done under general anesthesia and requires a one-night stay in the hospital. After the patient has been anesthetized, the surgeon implants the neurostimulator, which is about the size of a pocket stopwatch, under the skin of the patient’s abdomen. Thin wires, or leads, running from the stimulator carry electrical pulses from the stimulator to the sacral nerves located in the lower back.
MAINTENANCE: The battery inside the neurostimulator typically needs to be replaced every 3 to 5 years. The battery life will fluctuate per individual, depending on the strength of the signal needed to control symptoms and the amount of use each day. When it is time for the battery to be replaced, the entire neurostimulator will be replaced with a new one.
WHAT’S NEXT: Initially used to treat urinary symptoms, sacral nerve stimulation has recently also been used to treat fecal incontinence and constipation. The technique has been refined, by introducing a minimally invasive two stage implantation, so that patients can undergo a prolonged test stimulation using a permanent lead. Accurate neurophysiological evaluation can now be performed before, during, and after implantation and this has confirmed improved treatment success rates. For More Information, Contact:
Christopher Smith, MD Baylor College Of Medicine Houston cps@bcm.edu
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