Providing Relief From Bladder and Pelvic Pain Issues With Neuromodulation
Source: Beaumont Health
(Editors Note – Neuromodulation is a Step Four treatment option in the AUA Guidelines for the treatment of interstitial cystitis. There are two forms of neuromodulation: (1) post tibial nerve stimulation (aka Urgent PC) and (2) sacral/pudendal neurostimulation (aka Interstim). Because the latter has a significant risk of side effects, requires potentially numerous surgeries and can be quite expensive, most patients start with the less invasive Urgent PC first. You can read about this on our website at: https://www.ic-network.com/conditions/interstitial-cystitis/exploring-treatments/neuromodulation/)
Millions of people suffer from bladder dysfunction, including about 30 million in the U.S. One in seven women experience chronic pelvic pain. These are not only health issues, but quality of life issues. Because of the expertise of urologists at Beaumont Hospital – Royal Oak in treating bladder and pelvic pain, patients from across the nation, Canada and as far away as Australia seek their care.
“The patients we see have suffered a long time, affecting their quality of life and relationships with their kids and spouses,” says Ken Peters, M.D., chief, Urology, Beaumont – Royal Oak. “They are told they have to learn to live with it. I tell them they are going to be better. It really is amazing when you make somebody better, who no one else has been able to help.”
Dr. Peters recently presented three papers at the International Neuromodulation Society’s 12th World Congress. He and his team have had success in treating bladder issues and pelvic pain through a technique called neuromodulation.
Dr. Peters’ three presentations at the International Neuromodulation Society’s 12th World Congress in Montreal all addressed patient care issues. Each of these research studies was funded by the Ministrelli Program for Urology Research and Education, or MPURE. Below is an overview of each study:
Alternative therapy successful – pudendal neuromodulation after failed sacral stimulation
More than 90 percent of patients with bladder issues who did not respond to sacral neuromodulation, benefitted from pudendal neuromodulation.
Patients’ BMI did not change outcomes
Many clinicians have long held the belief that a body mass index, or BMI, of less than 30, was necessary to ensure a good outcome for neuromodulation procedures. Dr. Peters and his team found that patients with a BMI greater than 30 did have greater reoperation rates; however it did not change overall outcomes or complications. Says Dr. Peters, “Our study’s message: don’t shy away from overweight patients. They can benefit from neuromodulation, too.”
Does smaller bladder capacity impact neuromodulation outcomes?
It’s assumed that small bladders with less capacity will not benefit from neuromodulation as those with greater capacity. The Beaumont researchers found this not to be the case. Those patients with smaller bladder capacity, undergoing neuromodulation therapy, had success equal to those with normal bladder function. The data indicated that bladder size did not impact the outcome of neuromodulation.
Says Dr. Peters, “At Beaumont, we’re pioneers in pudendal neuromodulation. Come Sept. 25 and 26, we will be hosting another hands-on neuromodulation course for physicians across North America.”
Neuromodulation is an effective treatment for both women and men with urologic conditions. It involves providing electrical stimulation to different nerves – pudendal, sacral and tibial. The pudendal nerve controls the pelvic region, including the bladder and bowels. Pudendal neuromodulation involves attaching a tiny electrode to the nerve in the pelvis.
“When a heart signal goes bad, you put a pacemaker in to control it, “ explains Peters. “This is the same thing for the bladder. When the nerves are not functioning, we’re putting a pacemaker in to override the abnormal signals.” Depending on the patients’ symptoms and condition, the same technology is applied to the sacral and tibial nerves. Electrical stimulation to the sacral nerves, which are located near the tailbone and help control muscles related to bladder and bowel function are thought to normalize communication between the bladder and bowel and the brain, enabling improved functioned.
Dr. Peters and urologists at Beaumont have also studied the effectiveness of tibial nerve stimulation to treat overactive bladder syndrome, also known as OAB. Overactive bladder syndrome affects about 34 million Americans or 17 percent of the U.S. population. As baby boomers age, increased incidence of OAB can reduce quality of life, leading to social isolation.
Urologic Services at Beaumont
Beaumont urologists offer endoscopic, robotic and laparoscopic surgical options as well as traditional surgeries. They also specialize in treatment for kidney stones; painful bladder conditions such as interstitial cystitis; sexual dysfunction; urologic cancer; prostate conditions; male infertility; voiding dysfunction; and erectile dysfunction. In 2010, Beaumont opened a Women’s Urology Center, the first center in the Midwest dedicated and designed for women’s urological care and sexual dysfunction. Beaumont – Royal Oak recently received a “high-performing” regional ranking in Urology on the U.S. News & World Report’s “America’s Best Hospitals” list. Find out more at http://www.beaumont.edu/urology/.