Advanced Treatment for Overactive Bladder – Neuromodulation Therapy
Neuromodulation therapy works by addressing the communication lapse between your brain and the nerves that control your bladder. When these nerves are not communicating properly, the bladder has problems functioning as it should, resulting in incontinence issues.
The sacral nerves, located near your tailbone, carry signals between your nerves and the bladder and work to control the bladder and muscles related to urinary function. In OAB, these nerve signals do not communicate effectively with your brain resulting in bladder control problems.
InterStim therapy stimulates the sacral nerves with mild electrical pulses to modulate the communications signals with the brain. This treatment is safe and effective and is a viable option for patients who have not had success with lifestyle changes and first-line therapies for OAB.
InterStim Therapy is covered by Medicare in all 50 states and it is also covered by many major private insurance companies.
How InterStim Works
The InterStim system uses a small neurotransmitter device that can be compared to a pacemaker. To make certain this therapy is right for you, your doctor will start you with a test stimulator that does not require surgery. The test typically lasts five to seven days. The test stimulator involves temporary placement of a thin wire that is worn in your lower back. The wire is connected to a small external stimulator which is worn on a belt around your waist. The stimulator sends mild electrical impulses through the wire to one of your sacral nerves to “jump start” your bladder and stimulate it to work properly.
Implanting the InterStim Device
If your doctor determines that you’re the right candidate for this treatment, the InterStim neurostimulator device can be easily implanted under the skin in your upper buttock during a short surgical procedure. You will also have a small incision in your lower back where your doctor will place a long-term electrode. The neurostimulator will send electrical pulses through the electrode to one of your sacral nerves. You will also receive a patient programmer which tells you if the stimulation is on or off and the level of stimulation. Your doctor will set the stimulator to a level that is most effective for controlling your urinary symptoms.
Side effects of InterStim therapy are uncommon but may include pain, skin irritation, infection, device problems, and lead migration. In a clinical study, however, these side effects were resolved in most cases.
URGENT® PC Neuromodulation System
When other first-line therapies are not effective for treating overactive bladder, another type of neuromodulation therapy that targets the percutaneous tibial nerve, called Urgent PC, has been proven effective for some women with urgent urinary symptoms.
Urgent PC uses percutaneous tibial nerve stimulation (PTNS) to treat individuals with OAB symptoms. Your doctor will have you seated comfortably in the office where he or she will insert a small, thin needle electrode near your ankle. The electrode is connected to a battery-powered stimulator that emits mild electrical impulses along your tibial nerve in your leg and to the nerves in your pelvis that control bladder function. The slight electrical impulses inhibit frequent contractions of the pelvic floor and bladder muscles for better urinary control and less frequent urinary urges.
How Often are Urgent PC Treatments Given?
Your doctor will prescribe a series of 12 treatments, typically given once weekly for 30 minutes. Urgent PC inhibits some of your uncontrollable bladder contractions and it may take up to six weeks to see positive changes in urinary urgency. Every patient responds differently to the therapy, which is why your doctor will closely monitor your symptoms and perform necessary maintenance treatments after the initial 12 treatments.
Effectiveness of Urgent PC
Clinical trials have demonstrated that Urgent PC treatments are effective in up to 80% of patients. In a review of about 100 patients who had success with Urgent PC, symptoms improved anywhere between two and 12 weeks. For approximately 20% of the patients, symptoms of urgency did not improve after eight weeks.
The most common side effects associated with Urgent PC are minimal and temporary, resulting from placement of the needle electrode. These can include:
- Minor bleeding
- Mild pain or discomfort
- Skin inflammation