Monday, January 23, 2023

Bladder Implant For Overactive Bladder

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Finally A Diagnosis Of Interstitial Cystitis

Nerve Stimulation for an Overactive Bladder

Back in New Zealand, I found a pelvic floor physiotherapist. I realised through this therapy, that my pelvic floor was clenched on all of the time, creating more issues. With the therapy I learned to relax those muscles which, in turn, decreased some of the pain. After completing a second cystoscopy with yet another urologist, I was diagnosed with Interstitial cystitis with Hunners ulcers. I was so excited to have a name for this condition. Finally!!! This was good news. The bad news? There was no cure for Interstitial Cystitis.

The doctor put me on a low-grade anti-depressant which would dull my pain sensors in the vagina and bladder and hopefully give me some relief. This did relieve some of the pain, but I still had a swollen belly, lower pain in the abdomen, recurring UTIs and cystitis. Fantastic! Next, he lasered my bladder , hoping that the new skin that would grow would be healthier. This, although painful, had very little effect. Déjà Vu, I was starting to feel like a guinea pig and wondering when my Interstitial Cystitis would get manageable.

Concerns About Neural Damage Due To Sacral Nerve Stimulation

There has long been the concern that activation of electrodes near peripheral nerves could cause neurologic damage. Recent advances in electrode design and surgical implant technique have enhanced the safety of long-term peripheral nerve stimulators. In animal experiments conducted in the 1970s, prolonged high-frequency stimulation was shown to be associated with early axonal degeneration. On biopsy this appeared as salt and pepper lesions, showing a mix of damaged and normal axonal fibers. The damaged fibers were generally large-caliber Aa- and Ab-type axons, innervating muscle spindles and carrying tactile and proprioceptive inputs .

Natural Treatment For Overactive Bladder

Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. Research suggests that these nondrug remedies can be very effective for many women, and they have almost no side effects.

But before starting any OAB treatment, itâs important to understand bladder function and what things may cause overactive bladder.

Another way to strengthen pelvic floor muscles is electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum.

Until you get your overactive bladder under control, wearing absorbent pads can help hide any leakage.

Other lifestyle tips for preventing incontinence include:

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Management Outlines Of Ptns

Patients complaining of urinary frequency , and the urgency with or without incontinence must do urine analysis to detect UTI or any other obvious pathology. After exclusion of urinary tract-related problems, we can diagnose it as OAB. Moreover, we search for the accompanying symptoms and signs that may differentiate neurogenic from non-neurogenic OAB syndrome, in which treatment plans can be accordingly decided. PTNS emerges as one of the best modalities to treat this bothersome issue, either percutaneous, transcutaneous, or as an implant PTNS .

The authors declare that there are no conflicts of interest.

Complication Rates By Type Of Sling

Sacral nerve stimulation for overactive bladder and pelvic pain

Before undergoing bladder sling surgery, women should ask their doctors about the technique they plan to use. Complication rates may vary depending on the type of mesh sling and technique.

A 2010 study of bladder sling procedures by Z. Chen and colleagues published in Urologia analyzed the outcomes of 187 women who received bladder slings to treat stress urinary incontinence. Authors found that transobturator vaginal tape inside-out and transobturator vaginal tape out-inside are simpler techniques with fewer complications compared to tension-free vaginal tape .

Women who used TVT had an average hospital stay of five days versus about two days for the TOT group.

The complication rate in the study was:

  • 15.6 percent for tension-free vaginal tape
  • 9.20 percent for transobturator vaginal tape inside-out
  • 8.90 percent for transobturator vaginal tape out-inside

Complications from the procedures included discomfort with urinating, bleeding outside blood vessels and dysfunction of lower limbs. TVT was the only procedure associated with bladder perforation. Despite the complication rate, doctors found the slings safe.

The three tension-free urethral suspension techniques have similar efficacy, all of them are safe and effective procedures for the treatment of female SUI, authors wrote.

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Bladder Augmentation For Overactive Bladder

Bladder augmentation is quite usually the last resort when finding solutions for OAB. This is major surgery and it requires a complete size adjustment of your bladder and is irreversible.

For the bladder augmentation surgery, they start by cutting open the top of the bladder, opening it up like a clam, removing a large section of the intestine of the GI tract, open the GI tract, and place it on top of the bladder to increase its holding capacity.

It is usually successful in that it stops overactivity of the bladder, however, there is a very high chance, about 80 percent of patients who receive this surgery, have no feeling left in their bladder at all. They do not receive signals to the brain of having to urinate.

For those struggling with intense OAB, this is a benefit in that they will decide when they want to void by cathing. This surgery is not usually approved for younger patients as this is a last resort, as well as you would have to cath to urinate for the rest of your life. It benefits the patient by swapping an overactive bladder or painful bladder experience for no overactivity and the chance to decide when they need to pee.

What Are The Side Effects

The SNM procedure is very safe and has not been associated with any death. The majority of adverse events experienced were of a relatively minor nature. In a report to the Medical Services Advisory Committee of Australia:

  • The most commonly reported clinical adverse events were

  • Pain of undefined location and severity

  • Pain specifically at the implanted pulse generator site

  • Infection

  • Lead migration was reported at 7%

  • Approximately 16 % of patients required lead revision or replacement, frequently in order to optimise the clinical effectiveness of the device

  • Device removal was reported at a rate of 9.9% in the implanted patients. This is usually done because of infection, lost efficacy, or pain.

If you want to know whether sacral neuromodulation can help your bladder problems, contact us.

For more specific information on the Testing Phase procedures and instructions and the Implant Phase read Sacral Neuromodulation – User Info.

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Wake Forest Baptist Health Urology Named Interstim Center Of Excellence For Overactive Bladder Care

Wake Forest Baptist Health Urology has been named an InterStim Center of Excellence, making it one of a few in the country to earn this prestigious designation for treating overactive bladder and incontinence.

The InterStim Center of Excellence, awarded by Medtronic, recognizes physicians who demonstrate exemplary use of the InterStim System and a commitment to patient care for those suffering from symptoms associated with overactive bladder, accidental bowel leakage and urinary incontinence. As many as 30 percent of men and 40 percent of women in the United States live with overactive bladder symptoms, according to the Urology Care Foundation.

Robert J. Evans, MD, a board certified urologist and professor of urology and obstetrics and gynecology, is one of a few urologists in the state to offer and implant the MRI compatible InterStim neuromodulation lead. Evans has also been named the Interstitial Cystitis /Bladder Pain Syndrome Doctor of the Year for the last seven years, based on world-wide polls of interstitial cystitis patients.

InterStim Therapy, also known as sacral neuromodulation, uses an implantable device to send mild electrical impulses to stimulate the sacral nerves. Those nerves control the bladder and the muscles related to urinary and bowel function.

The Center of Excellence designation is awarded based on several criteria, including:

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Am I A Good Candidate For Interstim Therapy

A pacemaker for your OVERACTIVE bladder?! | Everything YOU need to know

Your specialist at Urological Associates determines if youre a good candidate for InterStim therapy after doing a comprehensive exam and reviewing your medical history. You may be considered a candidate for the implant device if you have severe overactive bladder and have already tried lifestyle modification and medications, and yet failed to get relief from your symptoms.

After its been decided that you may benefit from InterStim Therapy, your specialist conducts a trial run of the neuromodulation unit to see if it helps you. During the test run, which may be a week or more, the nerve stimulators are placed on your sacral nerves and you wear the testing device on your clothing. Your doctor at Urological Associates closely monitors your experience during the test run to see if you would benefit from the implanted device.

If you find that InterStim therapy improves your bladder control, then your specialist can place your implant device under your skin. The implant is very small and sends the electrical impulses to your sacral nerves to improve bladder control.

You can stop your InterStim therapy at any time by turning off the device or having it removed.

Overactive bladder can significantly affect your quality of life. If medication and lifestyle modification have failed to improve your bladder control, then you may want to consider InterStim therapy. Call Urological Associates today or book an appointment online for an evaluation.

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How Does Interstim Therapy Work

It is believed that one possible cause of overactive bladder is miscommunication between the brain and the sacral nerves when the brain and sacral nerves dont communicate correctly, the nerves will not tell the bladder to function correctly, which can cause bladder control problems.

The theory behind InterStim® Therapy is that gentle electrical stimulation of the sacral nerves reduces the signals to the nervous system which may be causing bladder control symptoms such as leaks, the sudden urge to go, or going too often.

Ecoin From Valencia Technologies

Finally, theres the eCoin. Like RENOVA and the StimRouter, the nickel-size device must be implanted in an outpatient procedure.

But unlike other devices, the eCoin is entirely self-contained. Its programmed by a clinician before it goes in to the lower leg, then it automatically provides stimulation at regular intervals so you dont have to think about it.

One drawback is that the battery inside the device must be replaced every three to five years. For anyone who doesnt want to worry about treatment schedules, though, that replacement just might be worth it.

The eCoin is currently recruiting patients for a trial of the device, and results are expected in early 2020.

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What Is The Outlook

You may need to try different treatments until you have relief of your symptoms. It is important to know that none of the treatments usually works right away. It can often take weeks to even months before you notice an improvement in your symptoms. Even with successful treatment, your IC/PBS may not be completely cured.

However, most patients can have significant relief of their symptoms and lead a normal life with the right treatment. You may find that you still experience some symptoms, however, and may find that you constantly have to pass urine more frequently. It is likely that you will always have to avoid certain types of food that have made your symptoms worse in the past.

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Renova From Bluewind Medical

Why is InterStim Therapy Effective against Overactive Bladder?

The RENOVA is a batteryless, leadless implantable device that stimulates the tibial nerve nerve without necessary visits to a clinic for regular treatments.

The stimulator is either implanted or injected near the tibial neurovascular bundle. Then the user places an external control around their ankle for treatment sessions, which are programmed by a physician.

Your doctor can adjust session durations and the strength and frequency of the electrical impulses using a computer program.

A clinical trial for the RENOVA began recruiting in December 2018, with results expected in December 2020.

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The Best Solution For Overactive Bladder

Advanced Interstim is an amazing treatment to permanently fix overactive bladder with incredible precision. It is done as an outpatient in our state of the art surgery centers with the best outcomes. Advanced Urology has the only Medtronic Center of Excellence in the World. We are the best in fixing OAB. Most importantly, we can help you.

DONT STRUGGLE WITH BLADDER CONTROL

Medicines often do not work and have many side effects. Constantly running to the bathroom to urinate or having to wear diapers is detrimental to your health and quality of life. We are experts in urinary control.

ADVANCED TECHNIQUES: BETTER OUTCOMES AND LESS SIDE EFFECTS

Advanced Interstim is a proprietary technique utilizing Medtronics Sacral Nerve Stimulation technology that provides the best outcomes with minimal side effects. This is similar to implanting a small pacemaker or nerve stimulator for the bladder. We utilize Advanced technology with 3D geospatial mapping to precisely fix the root cause of overactive bladder. This targeted millimeter accuracy improves outcomes and minimizes side effects. Urologists from around the world come to Advanced to learn from our talented team.

HOW DOES ADVANCED INTERSTIM WORK?

3 STEP JOURNEY TO SUCCESS

INITIAL VISIT

MINOR TESTING

MINOR PROCEDURE

ADVANTAGES OF ADVANCED INTERSTIM

Can Bladder Endometriosis Be Treated By Minimally Invasive Techniques

Yes, but only by an experienced surgeon. To resect a portion of the bladder and repair the bladder by video-assisted laparoscopy or robotic-assisted laparoscopy requires a high level of skill with those instruments. As mentioned, Drs. Nezhat were the first to perform minimally invasive surgeries for the treatment of all forms of endometriosis, including bladder endometriosis. After nearly 3 decades, Drs. Nezhat have now performed among the most, if not the most, endometriosis surgeries in the world using minimally invasive and robotic techniques.

A cystoscopy, as shown above, is a procedure in which a camera is placed inside of your bladder to help your doctor visualize your bladder and provide an accurate diagnosis.

However, even a cystoscopy can sometimes miss endometriosis that affects only the outside of the bladder. Therefore, multiple diagnostic tools are sometimes required to achieve an accurate diagnosis.

With the bladder so close to the uterus, its sometimes difficult for patients to determine from which organ the pain is emanating.

Thats why a careful examination is required so that your doctor can properly treat each area.

A common symptom of bladder endometriosis is urinary frequency. However, urinary frequency can also be a symptom of many other disorders.

Thats why its important that you receive a very careful examination to rule out other disorders.

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Seven Effective Treatments For Overactive Bladder

Overactive bladder occurs when sudden or frequent urges to urinate become hard to control, and can often lead to leakage .

In order to best treat overactive bladder, a urologist must pinpoint the underlying cause. Treatment will depend on symptom severity and the degree to which they impact someone’s quality of life. In general, there are three approaches to treatment: medication, behavioral interventions, and surgery.

Who Is Not Suitable For Treatment With Sacral Neuromodulation

Interstim Neuromodulation for the Treatment of Overactive Bladder Incontinence

InterStim® therapy is not recommended for usage in:

  • People in whom the stage 1 trial or test stimulation was unsuccessful
  • People who are unable to properly operate the hand held patient programmer
  • People with urinary blockage
  • Movement or migration of the pacing lead
  • Mechanical problems with the device
  • Interactions with other devices or diagnostic equipment such as MRI
  • Changes in urinary or bowel function which are undesirable

Most of these problems can be resolved by changes in programming parameters of the InterStim® device.

Some patients with the permanent InterStim® device need reoperation before the pacemaker battery needs replacement due to:

  • Reduced or loss of effectiveness of the InterStim® device
  • Pain at the lead or pacemaker site
  • Infection of the device

It is thought that reoperation rates are reducing over time with refinements in the InterStim® device implantation techniques and equipment.

Dr. Karen McKertich

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A Bladder Pacemaker: Making Nice Between Your Brain & Bladder

Ever heard of a pacemaker? Im sure you have because the device is fairly common, but I can bet my bottom dollar that the pacemaker youre probably thinking of is for the heart. Over here we like to talk about the land of leaks, so the pacemaker were going to tell you about is actually a bladder pacemaker.

Lifestyle Fluids And Diet

A few small changes to your lifestyle could help to alleviate urgency and frequency symptoms associated with an overactive bladder . It is important to make sure that you are drinking enough fluids to avoid bladder irritation and infection. It is advisable to limit your intake of fizzy drinks, caffeine and alcohol. More advice on Lifestyle, Fluids and Diet.

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Improvements To Tibial Nerve Stimulation

Another OAB treatment modality included in the recent review is percutaneous tibial nerve stimulation . Physicians insert a small needle into the ankle to stimulate the tibial nerve once a week for the first three months, followed by ongoing monthly appointments .

Tibial nerve stimulation for OAB.

Two new implantable TNS devices have potential to eliminate the need for the frequent office visits. One is the Bioness StimRouterTM neuromodulation system. It has an implanted lead with an integrated receiver, anchor and three electrode contacts in close association to the posterior tibial nerve. The lead captures stimulation energy that is delivered wirelessly and transdermally from a rechargeable external pulse transmitter and electrode patch. Both the transmitter and patch are worn only during periods of stimulation. The patient uses a programmer to track usage and change programs. The programmer controls the external pulse transmitter wirelessly. Dr. Goldman is the site principal investigator for an ongoing clinical trial of this technology.

BlueWind Medicals RENOVATM TNS device can be surgically implanted or percutaneously injected in close vicinity to the tibial neurovascular bundle. Powered through wireless technology, this device includes an external control unit worn around the ankle during treatment 30 minutes daily. Using a computer program, the physician sets stimulation parameters for each patient to optimize therapeutic outcome.

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