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Bladder Pacemaker to improve quality of life for incontinence patients

Emory University : 22 February, 2007  (Technical Article)
Apprehension about long road trips and four restroom visits during the night had become the norm for Juanita Bowman. Compared to a person with a normal bladder who uses the restroom four to seven times per day, a cup of water could send her to the restroom up to three times in an hour and a half. But after an alternative procedure for overactive bladder that Bowman, age 69, received at Emory Hospitals, her leaking episodes have been completely eliminated.
'Before the implant, I couldn't control my bladder at all. I had to wear a pad and I felt so dirty by the end of the day,' Bowman says. 'It was to the point that I was considering having to quit my job. Even during the night, I couldn't make it to the restroom in time. As soon as I got the message, my bladder would go.'

Bowman is one of nearly 100 patients that have been treated since 2001 at Emory University Hospital and Emory Crawford Long Hospital by urologists Niall Galloway, MD, FRCS, and Jenelle Foote, MD, using the InterStim therapy, developed by Medtronic, Inc. It is an implanted stopwatch-sized device that acts as a 'pacemaker' by determining the rate of firing of the muscles in the pelvic floor and can change the way the bladder and bowel behaves.

'This implant changes the way the bladder nerves work by influencing the rate that the nerves are firing, much like a cardiologist does with a pacemaker,' says Dr. Galloway, associate professor of urology and medical director of the Emory Continence Center. 'Without this sort of advanced technology, patients with severe incontinence would have to endure major reconstructive surgical operations that could possibly create new problems for them.'

Drs. Galloway and Foote performed the first InterStim procedure in Georgia and both have been pleased with the results. 'The procedure's effectiveness has exceeded my expectations,' notes Dr. Foote, who performs the procedure at Emory Crawford Long Hospital. 'Approximately 80 percent of my patients who undergo the procedure are experiencing a relief of symptoms.'

The InterStim therapy is a three-stage procedure that includes a test stimulation, surgical implant and post-implant follow-up. For the test phase, the patient wears an external stimulator for approximately one to four weeks that sends mild electrical pulses to the sacral nerve via a temporary lead that is implanted under the skin. If the trial is successful in reducing or completely eliminating their leaking episodes, the temporary lead is then replaced with a timed lead and extension that is connected to the neurostimulator, which can be surgically implanted as an outpatient procedure while under local anesthesia. The neurostimulator is activated using a hand-held electromagnetic device that can be non-invasively adjusted for the strength of the stimulation.

Bowman, who last fall was anxious about going on her church's road trip to Cape Cod, has regained her confidence.

'I was on pins and needles. It makes you a nervous wreck because you constantly think about it because you don't want to have an incident and be embarrassed,' she says. 'Now I have no leakage or spasms at all and I have plenty of time to make it to the restroom.' Because the lifespan of the neurostimulator batteries is 8-15 years, there are few necessary interventions following the procedure. The InterStim therapy is completely reversible and can be discontinued at any time with no damage to the nerves. Complications, including the possibility of infection that is always a risk of surgery, are very rare.

The InterStim therapy is covered by Medicare and most private insurance companies. For more information please call the Emory Healthconnection at 404-778-7777. Both Drs. Galloway and Foote say the number of incontinence sufferers who could benefit from the procedure is enormous.
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