Electrical Implant Could Help Incontinence Sufferers Control Their Bladder

A continuous shock to the nerves that control the bladder could help people with urinary incontinence that have run out of other options, according to a new review of studies.

Researchers the from the Dunedin School of Medicine (New Zealand), and Christchurch Hospital (New Zealand) reviewed eight published studies involving 500 patients who underwent sacral neuromodulation with implanted devices, and who had not responded to other less invasive treatments. The reviewers clarified that since it was uncertain whether some reports included patients who also appeared in other reports, no data were pooled from the different studies. The reviewers also said that most of the longer-term studies had a poor follow-up rate, which meant that there were questions about their reliability. Additionally, many of the implants did not work, and many required revision operations.

Overall, the results of the studies showed benefits primarily for patients with symptoms of overactive bladder and with no known obstruction, who had failed other methods of treatment. However, the reviewers stressed that up to 30% of those who are evaluated for the implant are not good candidates and do not receive an implant. Of those who get the implants, another 30% might not see any benefit or find that the implants lose usefulness over time. According to the authors, those who would benefit from the procedure fall into two groups: patients in whom all nonsurgical approaches have been tried and whose symptoms remain bothersome and persistent, and those who are unable to empty their bladder, yet have no discernable mechanical obstruction. The review was published in the April 15, 2009, issue of The Cochrane Library.

"For those who have tried all nonsurgical approaches - including bladder retraining, physiotherapy for the pelvic floor muscles and medications - yet the symptoms persist, it is worth discussing this option with your primary care doctor, who may refer you on to a urologist," said review coauthor Edwin Arnold, M.D., of the department of urology at Christchurch Hospital. "This treatment is not for everyone and even if the operation is undertaken, it does not always work, so a patient's expectations should remain realistic."

Sacral neuromodulation involves a continuous electrical nerve stimulation of the sacral nerve roots, using two implanted electrodes near the sacrum (tailbone), and an implanted pulse generator that generated a continuous shock to the nerves that control the bladder, causing the person to feel an uninterrupted tapping sensation in the pelvic area. However, many questions remain about patient selection and the best way to use these devices.

Related Links:
Dunedin School of Medicine
Christchurch Hospital