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Bladder Treatment Update: InterStim Neuromodulation and Male Slings
There are five types of urinary incontinence: urge, stress, mixed, functional and overflow. The specific type of bladder dysfunction can usually be diagnosed by history, physical examination, voiding diary and urinalysis. However, certain factors such as: recurrent urinary symptoms, recurrent infections, hematuria, prior surgery, vaginal prolapse, neurologic disease or incomplete bladder emptying warrant a more extensive urologic work up.
The “overactive bladder” is a common disorder consisting of symptoms of urinary urgency, frequency, nocturia and urge incontinence. First line treatment of the overactive bladder consists of behavioral therapy with or without pharmacological therapy, and, occasionally, newly available procedural intervention. The current mainstay of pharmacological therapy is long or short acting anticholinergic medication such as: oxybutnin (DitropanXLTM), tolterodine (Detrol LATM), flavoxate (UrispasTM) and hysocyamine (LevsinTM).
When conservative therapy fails, treatment with InterStimTM Neuromodulation is considered. This highly effective and safe procedure utilizes a pacemaker-like device which hyperstimulates the peripheral nerves innervating the bladder, often producing dramatic, subjective improvement in patients with severe urgency, frequency and incontinence.
Stress urinary incontinence occurs when the pressure inside the bladder overcomes urethral closing pressure, resulting in loss of urine during sneezing, coughing, physical exertion or any activity that increases intra-abdominal pressure. Previous child bearing, post-surgical damage and/or neuromuscular disorders can all contribute to stress incontinence. By quantifying abdominal leakpoint pressures with urodynamic testing, stress incontinence caused by either intrinsic sphincter deficiency (ISD) or uretheral hypermobility can be differentiated. Because there are yet no approved pharmacological agents available for the treatment of stress incontinence, surgical intervention is usually required.
It is well documented that pubovaginal slings and open bladder culposuspensions provide the best results to date in the treatment of female stress incontinence. Alternatively, effective treatment for male stress urinary incontinence can involve surgical placement of either a prosthetic genitourinary sphincter device or a “Male Sling.” The male sling, utilizing cadaveric allografts, is a safe, new approach for treating stress incontinence. Tri-County Urologists is proud to offer both of these new and exciting FDA approved treatments – InterStim Neuromodulation and the Male Sling – to our patients.
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