Have you tried treatment for overactive bladder and still suffer from any of the symptoms below?
Urgency to get to the restroom in time
Increased frequency of urination
Getting up at night 2 or more times to urinate
Wearing adult protective undergarments or pads
Inability to empty your bladder completely
Curbing your usual activities because you must be near a restroom at all times
If you are a man or woman who said yes to any of these, then you should know about some of the advanced therapies that are available and can drastically improve your quality of life.
Commonly used therapies such as behavioral modification, bladder training and medications are a first line of therapy for overactive bladder (OAB). Unfortunately, in many patients, these do not work or don’t work well enough. Some patients may even be unable to tolerate the common side effects of medications such as dry mouth, dry eyes or constipation. If you or someone you know has OAB, the use of sacral neuromodulation or Botox may be the answer. In a specialty trained urologists’ hands these treatments can succeed where others have failed.
Sacral neuromodulation (SNM) allows regulation of the nerves that go to the bladder. This works by sending messages back to the brain to regulate the “on-off” switch for bladder function. A simple way to think of SNM is as a pacemaker for the bladder. It can help to bring your bladder function back to normal function if it is too active or even underactive.
SNM is approved by the FDA for the treatment of refractory OAB, urge incontinence and urinary re-tention. Currently one company (Medtronic Inc., Minneapolis) produces this SNM device for internationall use under the name InterStim®. In Europe, it is also used successfully to treat bowel dysfunction including severe constipation, fecal urgency, frequency and fecal soiling. This is possible because there are nerves in the pelvis that work on both the bladder and bowel.
SNM is a very appealing option to patients due to its high success rate (up to 80%) and a unique trial phase. This trial phase of 3 to 7 days is called a percutaneous nerve evaluation (PNE) and is a simple procedure that places a thin temporary lead next to the nerve that controls bladder function. This can be placed using local anesthesia or light sedation and takes minutes to perform. This gives the patient the ability to “test drive” the device without going through the full implant. It also helps patients to gain insight on just how much the InterStim could help them. At the end of the trial, the leads are removed in the office without damaging the nerve.
If the PNE is successful in reducing symptoms, it is likely that the full implant will work in these patients. The InterStim uses an implantable lead and small battery that are placed for long-term treatment of OAB or urinary retention. Once placed, the InterStim can last up to ten years depending on its use. The battery can be easily changed under local anesthesia. After implantation, the InterStim is virtually undetectable even in a bathing suit. This device can drastically improve a patient’s quality of life.
BOTULINUM TOXIN (Botox)
Botox injections are another option in the treatment of OAB. The Botox is placed directly in the bladder muscle for treatment of OAB and urge incontinence.
This is done with a simple cystoscopy (small telescope) and can be done under local anesthesia or sedation. It works by binding to nerve endings allowing for relaxation of the bladder muscle. This has been shown to improve symptoms in up to 70% of patients and up to 60% of patients will have complete resolution of their OAB or urge incontinence. Botox, however, only lasts 6 to 9 months and needs to be repeated. The FDA considers this an off-label use even though it has been used successfully for years. Use of Botox in the bladder carries no greater risk to the patient than cosmetic procedures.
These are only a few of the many options that can significantly improve quality of life. A full range of treatments for OAB and any other urologic concerns are offered at Advanced Urology Institute.
Advanced Urology Institute