InterStim Therapy Improves Bladder Control

By  //  February 19, 2012

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EDITOR’S NOTE: This feature is courtesy of SpaceCoastMedicine.com Magazine – Brevard County’s most respected, most read health and medical resource for both consumers and healthcare professionals. To subscribe to SpaceCoastMedicne.com Magazine call 321-615-8111 or e-mail SpaceCoastMedicine@gmail.com

UROGYNECOLOGY

There has been a lot of talk about robots in medicine but the treatment for overactive bladder is usually non-surgical, therefore robotic surgery, which is similar to laparoscopic surgery, is unlikely to afford an improved approach to management. However, there is a very small implantable device that creates the sense of having a robot controlling your bladder for you.

A week after implantation of her little “robotic” device called the InterStim® Therapy system, a patient returned for a follow up visit and asked, “Why doesn’t everybody have an implant like this? I am normal again. I have my dignity again and played golf without bathroom breaks. I can not begin to tell you how happy I am with my implant.”

Another patient who suffered from an overactive bladder and had failed every other treatment was, like a lot of patients, hesitant about an implant.

DOCTORS HAVE REFERRED to InterStim Therapy as a “pacemaker” for the bladder. InterStim Therapy helps control bladder problems by sending mild electrical pulses to target the communication problem that exists between the sacral nerves (located near the tailbone) and the brain.

“I am not sure if I really want something inserted just above my buttock,” she said.  The patient came back after a month and said, “This is no life. The overactive bladder rules my life. I’ll try it.” She underwent InterStim® implantation and has since referred numerous of her friends, who have similar problems, for the same procedure.

The InterStim® Therapy system provides what is called “sacral neuromodulation,” a proven treatment option for urinary and bowel control.

This implantable system sends mild electrical pulses through a lead to the sacral nerves to modulate the neural activity that influences the behavior of the pelvic floor, lower urinary track, urinary and anal sphincters, and colon. It is very effective for patients with urinary urgency and frequency as well as urinary incontinence and retention.

A distinct advantage of sacral neuromodulation is that you can “test-drive” it for potential success prior to moving on to long-term therapy. A temporary stimulator can be inserted as an outpatient in the office under local anesthesia.

This evaluation gives patients and physicians an opportunity to find out in as few as 3 to 7 days whether adequate symptom reduction is achieved.  After the trial, the temporary stimulator is removed in less than a minute and then the decision is made regarding placement of the permanent device.

Outpatient Procedure

The InterStim® Therapy device implantation is done as an outpatient in the operating room of the hospital or an ambulatory surgery center, requires only local anesthesia and possible mild IV sedation.

The system is programmed at the time of implantation and routinely does not require reprogramming as long as it is performing up to expectations.

Like any procedure, implantation of the InterStim® device carries with it possible complications. Although rare, adverse events that may occur include pain at the implant site, lead migration, infection, technical or device problems, adverse change in bowel or voiding function, and undesirable stimulation or sensations.

The InterStim® intermittently delivers a small impulse to the nerve that when you focus on it can be felt in the vagina. Obviously you are not “being shocked” the whole day.  You are only aware of it by really focusing on it.

Even though for a lot of patients the InterStim® device has been proven to be their “magic robot,” it is not the first step to treat overactive bladder.

If bothered by frequency and an urgency to go, and loss of urine before getting to the bathroom, the first step in management is pelvic muscle control exercises and non-invasive nerve stimulation.

IF BOTHERED by frequency and an urgency to go, and loss of urine before getting to the bathroom, the first step in management is pelvic muscle control exercises and non-invasive nerve stimulation.

For starters, this treatment regimen can have a tremendously positive effect, but is definitely more structured and sophisticated than the usual Kegel exercises at home.

Biofeedback Program

I use a personalized computer enhanced biofeedback program to teach patients how to control and contract pelvic floor and sphincter muscles as well as some passive stimulation of the muscles and nerve.

Medications also play a role in the treatment of overactive bladder, but the muscle training should usually come first. Tibial nerve stimulation, which indirectly works on the nerves controlling the bladder, is non-permanent nerve stimulation, which may also be effective before resorting to the InterStim® system.

Marja Sprock, MD FACOG at Central Florida UroGynecology in Rockledge is a board certified OB/GYN with fellowship training in urogynecology and special expertise in cosmetic gynecology. She is an expert in the diagnosis and treatment of urinary urgency, frequency and loss, as well as G-spot enhancement and other cosmetic urogynecologic  surgeries. For more information log on to cfurogyn.com or call 321-806-3929.

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