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Revolutionary New Procedure Performed by Saint Barnabas Urologist Helps Those with Intractable Urinary Problems LIVINGSTON, N.J.--A Saint Barnabas Medical Center urologist, nationally recognized as an expert in the field of urinary incontinence and bladder dysfunction, has found success with a revolutionary procedure for patients with severe bladder dysfunction. Yitzhak Berger, M.D., is one of only a few physicians in the state who are experienced in performing sacral neuromodulation on patients with interstitial cystitis (IC) and overactive bladder who have not responded to conventional methods of treatment. In sacral neuromodulation (Medtronic, Minneapolis, MN), a permanent electrode is implanted in the body to override the pelvic stimulation that results in bladder irritation or involuntary contractions. Diana Titus, one of Dr. Berger’s patients who has found great success with the procedure, recalls her life preceding the surgery. The bladder problems that plagued her over a four-year period progressed from bad to much, much worse. What started as discomfort and frequent urination in 1996 became an excruciating lower abdominal pain and incontinence by 1998. The pain, which was caused by severe cystitis, radiated around to Ms. Titus’s lower back and reached a level of nine on a scale of 1 to 10, she relates. “I never slept because the pain was so severe and because I had to go to the bathroom so frequently,” recalls Ms. Titus. “Sometimes my husband would stay up and try to comfort me. Medication did help at all and it was difficult to concentrate on anything with that degree of pain. It destroyed me physically and emotionally. I could not believe that this was my quality of life at age 29.” Ms. Titus was retaining a tremendous amount of fluid, which made dressing difficult. She also urinated frequently, with an average of 15 to 20 trips to the bathroom during the night. She tried several common procedures, including cystoscopy under anesthesia with hydrodistention (stretching the bladder wall) and and DMSO (anti- inflammatory cocktail of medications), but neither resulted in a lasting change of her symptoms. In September 2000, Dr. Berger performed sacral neuromodulation on Ms. Titus and the change was dramatic. “This procedure was a godsend,” she relates. “The pain changed within 24 hours. I had my first full night’s sleep in two years. It cut down on the urgency to urinate by 80 percent and the pain was 80 to 90 percent improved. It gave me a totally new perspective on life.” After the procedure, Ms. Titus delivered homemade chocolates to Dr. Berger and his staff as a way to thank them for “giving me hope again.” Approved by the Food and Drug Administration three years ago for the treatment of persistent overactive bladder, sacral neuromodulation is a treatment for the minority of patients who do not respond to more conservative modalities, including Kegal exercises, biofeedback and various medications. In sacral neuromodulation, a permanent electrode is implanted in the sacral (lower) area of the spinal cord through a small incision in the back. Subsequently, this electrode is connected to a stimulator, similar to a pacemaker. When the stimulator is active, the current that is delivered to the electrode (lead) constantly stimulates the pelvic floor muscles. This stimulation overrides the pelvic neurological impulses that are responsible for the bladder irritation in IC patients and the involuntary bladder muscles spasms in overactive bladder patients. The 45-60 minute procedure is performed on an outpatient basis with the patient under intravenous sedation. The electrodes and stimulator are inserted with the use of local anesthesia and are completely concealed under the skin. Before the permanent electrode is implanted, the urologist performs a percutaneous nerve evaluation test. A temporary electrode is inserted and the patient is connected to an external stimulator for one week to monitor symptoms with this therapy. This allows the patient and physician to determine if the procedure will positively benefit the individual. If so, the permanent device is implanted and later on the patient can control and adjust the level of stimulation based on his or her needs. The procedure, which has a low complication rate, is technically and technologically challenging and is currently being performed by only a select group of experienced physicians in the state and nationally. For those patients with persistent urinary difficulties, it can be life changing, says Dr. Berger. He explains that patients with overactive bladder need to urinate frequently and they experience a strong sense of urgency caused by a bladder muscle that develops involuntary contractions. These individuals often are unable to get to the bathroom in time and are therefor incontinent; and they are also prone to recurrent urinary tract infections. The symptoms often make daily life quite unbearable. “The leakage of urine and the urgent need to use the bathroom affects their quality of life,” says Dr. Berger. “Driving far distances, attending long meetings and not having a restful sleep at night can be a source of great stress for a person with overactive bladder.” The other types of patients who may benefit from this procedure are those with IC who develop severe pelvic pain due to irritation of the lining of the bladder. These individuals urinate frequently and have bladder pain like Ms. Titus, but they usually experience no leakage of urine. Dr. Berger, who has a practice primarily composed of female patients or others with voiding dysfunction, uses this treatment for treats about 20 IC and overactive bladder patients annually who do not respond to conventional treatment. The procedure provides varying degrees of relief for patients, from 60 to 100 percent improvement. Implantable neuromodulation systems have been used in the field of health care for many years in the area of pain management, particularly for chronic back pain and central nervous system disorders. Sacral neuromodulation is a new application using a similar technique. “I would tell people considering the procedure that they do not have to adapt to a poor quality of life,” says Ms. Titus. “They can do something about the situation. It is so worth it.” [ top ] |
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