March 26, 2010
‘Bladder Pacemaker’ Helps Control Urinary Problems
Patients who have a history of bladder control problems may benefit from an implantable device that uses electrical pulses to alter abnormal communication between bladder nerves and the brain, said a urologist at Baylor College of Medicine.
"Patients with these bladder issues often suffer from significant embarrassment and a low quality of life," said Dr. Christopher Smith, associate professor in the Scott Department of Urology at BCM. "This has been a life-changing treatment for some patients who have not responded to other therapies."Urinary conditions
The treatment, called InterStim Therapy, has been approved by the U.S. Food and Drug Administration for patients with urinary frequency and urgency; urge incontinence, characterized by involuntary leakage, usually associated with an urge to urinate; and urinary retention, an inability to urinate.
The bladder is controlled by the brain and sacral nerves, said Smith, a specialist in male and female incontinence and voiding dysfunction, or difficulty urinating. When there is miscommunication between the brain and the bladder nerves, the nerves cannot tell the bladder how to function properly, causing problems with controlling and emptying the bladder.
Helps control bladder function
The new treatment is like a pacemaker for the bladder, said Smith. It helps control bladder function by filtering signals that may be causing the problem.
"With overactivity, the treatment blocks the signals telling the brain to go often," said Smith. "With urinary retention, it filters signals to the lower pelvis to allow the pelvic muscles to relax and the bladder muscles to contract."
InterStim is recommended for patients who have not had success with diet and behavioral changes, or oral medications.
To determine if the treatment works, patients undergo a three to 14-day trial phase that tests the device's ability to improve symptoms.
"Through a needle, a temporary wire is passed through to the sacral nerves," said Smith. "The wire is attached to the skin and connected to an external stimulator worn by the patient that sends electrical pulses to the sacral nerves."
The test phase is required for getting insurance coverage, said Smith.
Minimally invasive procedure
If the patient's symptoms significantly improve, the temporary wire will be replaced with a permanent wire. Using a small incision, a stimulator will be implanted in the buttocks area and connected to the permanent wire in such a way that the whole device will be located beneath the skin, invisible to the naked eye.
Patients can control the intensity of the electrical pulses with a remote control.
"A major benefit of the treatment is that it is minimally invasive," said Smith. "It can be done in an outpatient setting using a local anesthetic."
Patients should have follow-up exams every 6 to 12 months, Smith said. The device is controlled by batteries that last for three to five years.
Smith said it's important to understand that patients who have obstructive issues such as benign prostatic hyperplasia (i.e. enlarged prostate), cancer, or urethral strictures will not benefit from this procedure.
Patients with multiple sclerosis, often characterized with bladder control problems, should consult their neurologists first if they are interested in InterStim.
"A majority of MS patients are followed up with magnetic resonance imaging, or MRI," said Smith. "As of now, MRI studies are contraindicated in patients with the device." However, there may be other scanning methods available for MS patients.
Patients who think they may be eligible to test this procedure should get a referral to see a urologist who specializes in this treatment.
InterStim is manufactured by MedTronic.
An estimated that 33 million Americans suffer from bladder control problems.
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