Men and women with an overactive bladder often find themselves dealing with unexpected accidents and a persistent urge to go. For patients who have tried other treatments for overactive bladder (OAB), such as medication, bladder training, and lifestyle changes, without success, neuromodulation may effectively manage symptoms. There are two different types of neuromodulation:
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With this type of nerve stimulation procedure, a small device is used to transmit electrical impulses to the sacral nerves. Located by the tailbone, these are nerves that affect muscles in the bladder and parts of the pelvic area. Sacral nerves also play a role in controlling the sphincter and pelvic floor muscles.
Pudendal nerve stimulation is a form of neuromodulation that targets a different nerve that controls bladder muscles. The implanted device is used to stimulate the pudendal nerve. Located in the pelvis and connected to adjacent sensory nerves, the pudendal nerve primarily affects pelvic floor muscles. Improving pelvic floor muscle control may also improve the functioning of the bladder muscles that manage urination flow.
The procedure is the same for both sacral and pudendal nerve stimulation. Prior to insertion of the leads that will deliver the electrical impulses, patients are typically asked to keep a "bladder diary" for a few days to track urination patterns and OAB symptoms. This information is used to establish a baseline for a comparison of symptoms experienced before and after an initial test stimulation.
No surgery is required for use of the test simulator. During a 5-7 day trial period, patients wear a belt around their waist. A thin wire worn in the lower back delivers impulses to either the pudendal or sacral nerves to improve the way nerve signals are sent from the bladder to the brain and vice-versa.
If patients see improvements with neuromodulation therapy, the device is then connected to a small battery under the skin where it serves as a permanent source of relief. Surgery involves the insertion of the device under skin in the upper buttocks. An additional incision is made into the lower back for the placement of an electrode to deliver the necessary electrical impulse.
Patients also receive a programmer that can be used to control stimulation levels. A urologist can initially adjust the settings to an appropriate level based on symptoms and details from the bladder diary. As patients get used to the device, they can control stimulation levels according to personal comfort.
Follow-up care usually includes regular examinations to ensure that the bladder and related structures are functioning properly. Side effects associated with neuromodulation are generally mild. Some patients may experience skin irritation and infection. In rare cases, there may be problems with the implanted device or electrode.
Should nerve stimulation fail to sufficiently control OAB, a urologist may recommend surgery to increase bladder capacity, which requires intermittent use of a catheter. In severe cases, and only if all other options haven't been effective, the bladder may be removed and replaced with a urinary diversion that involves the creation of an alternative way for urine to be collected and/or transported.
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