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Urology

InterStim therapy helps patients with overactive bladder or chronic pelvic pain lead normal lives

10/01/2006

InterStim therapy, an implanted neurostimulation system, sends mild electrical pulses to the sacral nerve, a nerve near the tailbone that influences bladder control. This continuous electrical stimulation, which is nearly imperceptible to the patient, helps reduce or even eliminate bladder control problems in some patients. The therapy has proven effective for urge incontinence patients who have not responded to medications or behavioral treatments. UCLA leads the nation in InterStim implantations, and physicians in the Department of Urology have expanded use of the Food and Drug Administration-approved device to treat other medical conditions as well. Conventional InterStim therapy can help patients with:

  • overactive bladder
  • non-obstructive urinary retention

Conventional InterStim therapy targets a single nerve. However, UCLA urologist Shlomo Raz, M.D., developed a procedure called Caudal Neurostimulation that stimulates eight nerves at one time. The procedure has proven effective in patients for whom conventional InterStim therapy has failed. Caudal Neurostimulation can help patients with:

  • chronic pelvic pain
  • interstitial cystitis

Investigation of treatment mechanism may further expand uses

UCLA researchers are preparing articles on the expanded use of InterStim, reporting on its success with additional nerves stimulation. Researchers also are sudying the way neurostimulation works in the body, which may lead to additional applications. Researchers use Positron emission tomography (PET) to monitor both patients who respond to various stimulation combinations and those who do not.

Therapy tested on patients prior to implantation

Before implantation, the InterStim device is tested on patients to ensure effectiveness. An electrode is inserted, floating close to the sacral nerves and connected to an external device. For a week or more, the patient records changes in voiding patterns that occur with the stimulation in place. This record is then compared to prestimulation voiding patterns. Implantation is offered to patients who experience a significant improvement. The implantation is performed on an outpatient basis under slight sedation (twilight). The electrode’s electrical contacts connect to a neurostimulator, a stopwatch-sized device placed under the skin in the upper buttock. The system can be shut down at any time. Patients and physicians can regulate the stimulation with an external programmer, as required, until optimal response is achieved.

Possible adverse effects can include:

  • change in bowel function
  • pain at implant site
  • unpleasant stimulation or sensation
  • infection
  • movement of the wire

Patient referral

For a consultation or to refer a patient for InterStim therapy, please call (310) 794-7700.

Program leaders

Shlomo Raz, M.D.
Professor of Urology
Associate Professor of Urology

Larissa Rodriguez. M.D.
Associate Professor of Urology

Web resource

http://www.uclaurology.com/





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