Held hostage by the bladder

Soda pop used to be a nightmare for Sue Nelson. She was one of the 25-million people living with bladder control issues: 80-percent are women. Her bladder was telling her it was full, even though it wasn't: She couldn't leave the house.

Doctor Christopher Smith of the Baylor College of Medicine in Houston reached for this device. It's a pacemaker of sorts implanted into sue's lower back and weighing just an ounce. Electric stimulation sent to the base of the spine tells patients when their bladder is truly full.

Studies show 56-percent of users cut their bathroom trips in half, and 46-percent of patients had zero bladder control issues. And while Sue was never keen on talking about her problem, she'll happily tout the solution.

Experts say up to 75 percent of people suffering from over-active bladder don't respond to medication. People who want this device can wear an "external" version for 7 days before committing to full surgery.
 

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

(Information provided by Ivanhoe)