Wednesday, February 18, 2004

Implant relieves bladder problems

Many people try device after pills or surgery fail

By Emily Crawford
Columbia News Service

As a nursing educator, Colleen travels a lot for her job. But there was a time when she dreaded going on the road. For the first couple of hours everything would be fine, but then she would suddenly feel a painful pressure in her bladder, a sign that she needed to find a bathroom immediately. Because of a medical problem, Colleen's bladder would not signal to her body ahead of time that it was becoming full - until suddenly the pain would become almost unbearable.

Today, thanks to a new implant device, Colleen can travel again without fear. "I don't worry anymore about getting stuck on the road, going somewhere and not being able to go to the bathroom," she said. "I don't get the pain and the panic anymore."

Most people associate bladder control problems, including incontinence, with the elderly, especially older women. But urinary incontinence affects some 25 million Americans, including both women and men in the prime of their lives. One in four women between the ages of 30 and 59 has experienced incontinence, according to the National Association for Continence.

Can change lives

The new implant has the potential to change their lives. About the size of a half dollar, the gadget, called an InterStim, uses electrical stimulation to control the patient's bladder, much in the way a pacemaker regulates the heart.

"This procedure treats both ends of the spectrum, those who go too much and those who can't go at all," said Dr. Alan Garely, chief of gynecology at Winthrop University Hospital in Albany, N.Y. "The technique is useful for patients who fail traditional methods like oral medication. Of those patients, approximately 80 percent have excellent responses to the implant."

Introduced in 1997 by Medtronic, a medical device maker in Minneapolis, the implant is growing in popularity because of recent technical improvements that have boosted the procedure's success rate, Garely said.

Incontinence is usually caused by a muscle spasm in the bladder, though cancer or urinary tract infections can sometimes be the culprit. Medical experts acknowledge that doctors do not always fully understand what causes the bladder to spasm.

There are different kinds of bladder control problems that affect both women and men, including urinary frequency, urinary retention and urinary urge incontinence.

When traditional methods fail

Patients with bladder control problems are most often treated with medication, physical therapy and surgery. Some patients, however, do not respond to these traditional methods of treatment. They manage their condition the best they can, often wearing diapers or absorbent pads.

If they suffer from retention, like Colleen did most recently, they may need to use catheters to relieve themselves. (Colleen asked that her last name not be used because of a pending lawsuit related to a surgery she had a few years ago on her bladder.)

Originally introduced to help those with incontinence, the implant is now being used to treat patients with retention problems as well.

The implant is embedded under the skin in the patient's upper buttock. Inside the implant a small electronic device and a battery send electronic pulses via a lead wire. Through the lead wire, the electric stimulation travels to the sacral nerves, which are located near the lower spine and influence the bladder. The patient or the doctor can adjust the implant's settings with a remote control about twice the size of a computer mouse by holding the remote next to the skin.

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