Discover all of the innovative treatment options available at Urology Associates.
Today approximately 3.3 million persons in the United States, or 16.5% of our population, struggle with the problem of overactive bladder. As many as 50% of those over the age of 75 can experience significant symptoms. Overactive bladder includes symptoms of urinary urgency, the inability to postpone urination, frequent urination (sometimes as often as several times per hour and throughout the night) and leakage of urine requiring wearing of pads or changing of clothes. For many people, finding a public restroom when they need one can be a challenge. These conditions can be bothersome, embarrassing, and sometimes debilitating, to a point where people may not want to leave their home.
People are aware of many of the treatment options as TV commercials expose the public to many different medications for overactive bladder. The accepted treatment options are behavioral therapy (retraining of the bladder), biofeedback (also known as muscle rehabilitation with physiotherapy), medications, and injection of botulinum toxin (Botox) into the bladder, bladder surgery, and nerve stimulation strategies including peripheral tibial nerve stimulation (PTNS), and InterStim. The goal of treating someone with overactive bladder is choosing a therapy that will effectively treat the problem with few side effects. Often patients have struggled with the problem for many years before seeking help because they are embarrassed or do not believe there are successful treatments.
When more conservative measures fail, including medications, there are other treatment avenues available for urgency and leakage of urine and fecal incontinence. Recently, Urology Associates has been focusing on nueromodulation, or regulating the signals sent between the bladder, bowel, and brain. Neuromodulation treatments have been offered at Urology Associates over the last three years using PTNS. This involves placing a small needle, similar to an acupuncture needle, in the ankle and sending electrical impulses to the bladder via the tibial nerve. The treatment is not painful and is delivered in the office once a week over a several month period. Improvement in urinary urgency and frequency symptoms can be seen in 60-80% of patients.
InterStim is another option and can be simply described as a “bladder pacemaker”. The bladder is made of muscle, which is controlled by nerve fibers, which communicate with the brain. The brain sends the signal to the bladder to empty. In some patients those signals are sent at the wrong time. The InterStim device is used to regulate these signals to a more normal pattern. Patients are tested first to see if the therapy will be successful before placing a permanent implant.
Either in the office or under minimal anesthesia in the outpatient surgical center, a thin wire electrode is placed into the sacrum (the base of the vertebral column) and hooked to a stimulator the patient wears on their waist. If there is good response to the trial, a permanent stimulator and wire are placed. InterStim therapy was approved by the Federal Drug Agency in 1997 and has an excellent track record of success. It is suitable for many patients, even those who feel they are at the end of the line for treatment options.
Not only does InterStim treat urinary frequency and urinary incontinence but it is also indicated for urinary retention, or inability to urinate, in certain cases. Most recently, InterStim was approved for fecal or bowel incontinence. Sometimes, people are not even aware that the leakage is occurring. Studies have shown success rates up to 80 percent depending on the type of OVERACTIVE BLADDER incontinence. For many men and women, this is long-awaited answer they have been looking for. The InterStim device is used to regulate these signals to a more normal pattern. Patients are tested first to see if the therapy will be successful before placing a permanent implant. Placement of an InterStim unit does not preclude a patient from having a brain MRI, but they are unable to have body MRI’s.
Not only does InterStim treat urinary frequency and urinary incontinence but it is also indicated for nonobstructive urinary retention. Most recently, InterStim was approved for fecal incontinence. For many men and women, this is long-awaited answer they have been looking for.
February 1, 2014
Written By Amy K. McKerrow M.D.