InterStim Therapy for Bladder Control - University of Utah

1 InterStim Therapy for Bladder Control Explaining the test stimulation procedure Most people feel uncomfortable discussing What types of Bladder Control problems does Bladder Control problems with their friends, InterStim Therapy help? family and doctor. But if you suffer from any of the symptoms of overactive Bladder r Urge Incontinence: loss of urine when you feel (OAB), you're not alone. More than 33 million a strong need to go to the bathroom. Americans deal with OAB, defined as urgency r Urinary retention: Not being able to empty the frequency and urge incontinence. InterStim Bladder and having to use a catheter to empty. Therapy is a treatment option available for OAB. r Urgency, frequency: feeling like the Bladder is not emptying, passing only small amounts of urine and urinating frequently. What is InterStim Therapy ? InterStim Therapy is a reversible Therapy used How do I know if InterStim Therapy is to treat urinary incontinence, frequency and right for me?

2 Incomplete Bladder emptying. An implantable device is used and sends mild electrical pulses Your health care provider can help make this to the sacral nerves. Located near the tailbone, decision and may recommend that you try the sacral nerves Control the Bladder and the InterStim Therapy temporarily to see if it helps muscles related to urinary function. If the brain your symptoms. This is called test stimulation . and sacral nerves don't communicate correctly, InterStim is only offered to patients who have the nerves can't tell the Bladder to function tried medications and behavioral changes and properly. This communication problem can lead have not responded well or can't tolerate these to symptoms of overactive Bladder . treatments. What are the benefits of test stimulation ? With test stimulation , you can try InterStim Therapy for four to seven days and feel the stimulation of the nerves. This testing allows you and your health care provider to determine if the full procedure would be beneficial to you before having the procedure.

3 Before test stimulation is done, a visit with a surgeon is needed. What will my visit with the surgeon involve? r A physical examination r Review of your Bladder diary and medical history r A urodynamic study: a test of Bladder function that involves catheterization and filling the Bladder with water. r A cystoscopy: a procedure used to see inside Medtronic, Inc. 2010. the Bladder using a hollow scope with a lens. 1. How is the test stimulation procedure done? The top of the test stimulator has Once in the operating room, you will be given two indicator medication to help you relax. The surgeon will lights. A green numb the area around your sacrum (tailbone). blinking light While lying on your stomach, a needle will be means the unit inserted and guide the wires into the correct is on. A yellow place. To ensure the wires are placed correctly, light means the you will be asked where you are feeling the battery is low stimulation and special x-rays will be taken.

4 (replace with a Medtronic, Inc. 2010. You will feel a vibrating sensation in the vaginal 9 volt battery). If the stimulation stops, you may or rectal area. Once the correct sensation is need to turn the device off and then on again, achieved, the wires will be secured and a test and slowly increase the amount of stimulation . stimulator will be connected to the wires. If this does not help, the battery may need to be The test stimulator is worn on your clothing replaced. by clipping it to your waistband. After the procedure, antibiotics and pain medication may Are there special care instructions after my be prescribed. procedure? During the test week, it is important to avoid Are there risks with the procedure? sexual and strenuous activity to ensure the wires The risks are minimal and include: stay in place. Keep the operative sites dry and be careful to not pull the wires. r Bleeding r Infection Should I continue with my diary during the r Transient electrical shocks test period?

5 R Continued Bladder problems r Pain Yes. It is important to maintain your voiding diary during the test period. It will be compared Are other treatment options available? to your diary before the procedure to check progress. This diary is also important to the Alternative treatment options include: insurance company and used to make decisions about payment and determining if this is the best r Behavioral techniques. Therapy for you. r Managing your fluid intake. r Reducing Bladder irritants. r Learning to suppress the urge with special What follow up is involved with this techniques using your pelvic floor muscles. treatment? r Medications. The nurse will call you three-four days after r Self-catheterization (for retention). the procedure to discuss your response to InterStim treatment. How do I use the stimulator? If after the test period it is decided that you will You are able to Control the amount of move forward with a permanent stimulator, this stimulation you feel using the Control knob on procedure will be scheduled within a week.

6 After the stimulator. It is important you always feel the permanent stimulator is placed, you will the stimulation during the test period. You may have a two-week follow up appointment. Please increase or decrease the amplitude depending bring your pre and post diary to this visit so we on how much sensation you feel in the vagina or can place them in your chart. rectal area. It should always be comfortable! 2. Who do I contact with questions after the r You can remove the bandages and shower procedure? three days after surgery. r Gradually increase your activity level as your Please feel free to contact us with any questions incisions heal and you feel you are able. you have. r The device has been programmed and A nurse is available during the day between turned on. 8 5 : (801) 581-3565 r You should feel a slight tingling sensation in the vaginal area (women) or scrotal area (men). After hours: The on-call Urology resident is available.

7 Please call (801) 581-2121 and ask for Can I adjust the level of stimulation ? the on-call Urology resident. Your hand held battery operated device sends Where can I learn more about the Medtronic signals to your neurostimulator and can adjust InsterStim Device? the amplitude of stimulation . For additional information, you can contact us or refer to We are available to answer any questions you the patient packet manual packaged with the may have. You may also learn more at programmer. or call 1-800-328-0810. The neurostimulator battery cannot be recharged but will need to be replaced when it Frequently Asked Questions about no longer works. Batteries typically lasts five to the Permanent InterStim Device seven years. What are the What is normal stimulation ? components of the Unlike the test stimulation period, the InterStim Device? stimulation from the implanted device is not Implanted Parts constant and is often inconsistent.

8 Below are some guidelines on what to expect: Neurostimulator: (pacemaker) send r Intensity may increase or decrease with your mild electrical pulses position. through the lead. Medtronic, Inc. 2010. r You may not feel stimulation at all times. Lead: a thin wire that r If your Bladder Control is similar to what it carries the pulses to was during the test stimulation period, do not stimulate the selected turn up the amplitude. This will only cause nerve in the lower back. pain and decrease the generator's battery life. External Controller r If the stimulation is uncomfortable, decrease Wireless hand held device: the amplitude with your programmer. If it adjusts the strength of continues, turn the stimulator off. stimulation and allows you to turn the device on In what scenarios should I come in for an and off. appointment or contact my provider? Medtronic, Inc. 2010. What should I expect after r If you are involved in an accident or suffer my InterStim device has been implanted?

9 A fall. r If the device seems less effective at r Even with pain medication, it is normal for controlling your Bladder . Please bring the the incisions to hurt for the first two weeks hand-held device. after surgery. 3. r Medication may still be needed to fully Control At the airport, show your InterStim ID card leaking. You should continue with Bladder and ask those in charge to bypass the walk training and fluid management but if you through screener. would like medication, contact us. r General follow up appointments should be Do I need to carry the hand held device made two weeks after the permanent device with me? is implanted, then every three months the first year and every six months the second year, and You do not need to carry the hand held device yearly after that. with you at all times, but it should be available r We are happy to answer any questions you to you when you need to make adjustments to have about your InterStim device.

10 The stimulation the device is sending. What precautions should I be aware of? Is there anything I can do to protect the hand held device? Because of your device, there are certain procedures you cannot have. For your safety, Take care of your hand-held device. It costs always tell your doctor or medical staff about about $1200 to replace it. If applicable, we your InterStim device before undergoing any advise you add it to your home owner's tests or surgery. insurance policy. Procedures you CANNOT have: Questions/Notes Diathermy: short wave, microwave or ultrasound diathermy. _____. This Therapy produces energy that can be transferred through your implant and cause _____. tissue damage and result in severe injury and death. _____. MRI (Magnetic Resonance Imaging) _____. This Therapy may result in failure dislodgement, heating or induced voltages in the _____. neurostimulator and/or lead. _____. What about other radiology procedures?