Innovations

Bladder pacemaker provides relief and control

When Cassandra Waller went shopping, her first question upon entering a store was “Where’s the bathroom?”

The 41-year-old Salinas resident used to have to rush to the toilet 20 or 30 times a day. For some reason, abdominal surgery left Waller with a chronically inflamed bladder — a condition known as interstitial cystitis. “Imagine having the feeling of having to go all the time and not knowing when you truly need to go,” Waller says.

Waller’s days became ruled by her bladder. She felt intense pelvic pain, constant pressure to urinate, and an inability to hold it in. To cope, Waller stopped going out. She asked friends to run her errands. And everywhere she went, she found herself on the lookout for a handy public toilet.

After suffering for more than 18 months, Waller was referred to Monterey urologist Dr. Anthony Shaheen. The medication he prescribed brought only fleeting relief. As a last resort, Shaheen suggested a more permanent solution: a bladder pacemaker.

InterStim^® Therapy uses technology developed for heart patients to help people regain urinary control. The pacemaker device is wired to the nerve that controls the bladder. By emitting regular electronic pulses, it helps quell the storm of signals disrupting bladder function and helps individuals regain a more normal pattern.

“It’s a wonderful technology,” Shaheen says, “for patients who have already tried other options, such as eliminating caffeine and taking medications, but who have shown no improvement despite that. With this device, patients still get the normal sensation of control over the bladder. Patients that urinated 20 times a day have a more normal voiding pattern, and patients that got up 10 times a night to go to the bathroom are getting up three or four times a night.”

Clinical trials of InterStim show that about half of patients regain complete control over their bladder, while 80 percent enjoy an improvement in their symptoms. It has been approved by the Food and Drug Administration to treat overactive bladder, urinary retention, and other incontinence problems of neurological origin. These conditions occur in people of all ages but are particularly common in women.

“When I first heard about it, I was kind of skeptical,” Waller says. “I had been poked and poked, and I just didn’t want another surgery.” But after speaking with a happy InterStim recipient, Waller ultimately opted for the treatment.

Shaheen installed the device in two stages. During Waller’s first visit, he applied a local anesthetic to her lower back, then threaded a pair of wires into her tailbone. Talking with Waller to monitor her sensations, he made sure the wires were connected to the correct nerve and later confirmed their positions with an X-ray. At the end of the procedure, he attached the wires to an external pacemaker she wore on a belt.

Waller says wearing the external device felt peculiar. “You have to walk around for a week with these wires sticking out of you.” But she responded immediately to the treatment. Not only did her pelvic pain largely disappear, “I found the pressure to go to the bathroom was no longer there 24/7. I still had to go frequently, but I was able to feel when I really had to go, and that was a success to me.”

During a second visit, Shaheen implanted the permanent pacemaker beneath Waller’s skin. Its outline is barely visible below her waist, and the device causes her no discomfort. Waller can use a programming module similar to a remote control to modulate the pacemaker and turn it on or off. The pacemaker’s battery typically lasts from 7 to 10 years.

Right now, Shaheen is the only doctor in the Monterey area qualified to install the InterStim device. The procedure is typically covered by medical insurance. “It’s really made a dramatic change in people’s quality of life,” he says. “They can travel, they can sleep, and it’s amazing how much happier they are.”

Cassandra Waller, for one, says her life has much improved since she got the device. “I can feel when I need to go, and not having the pressure all the time is a relief. It left a little scarring, but I think it’s well worth the tradeoff.”

For more information about InterStim Therapy, log on to www.interstim.com.