Neuromodulation Therapies for Urinary Incontinence
Neuromodulation therapies use electrical stimulation to modulate the neural pathways involved in bladder and bowel control. These advanced treatments can be highly effective for patients who haven’t found success with more conservative approaches like lifestyle changes, pelvic floor physical therapy, or medications. There are three main types of neuromodulation used for urinary incontinence:
1. Sacral Neuromodulation (SNM)
Sacral neuromodulation involves implanting a small device that sends mild electrical pulses to the sacral nerves, which control bladder and bowel function.
Key Features:
- Minimally invasive surgical procedure
- Long-term therapy with implanted device
- Effective for both urinary and fecal incontinence
- Allows for a trial period before permanent implantation
Available Systems:
- Medtronic InterStim™ System
- Axonics® Sacral Neuromodulation System
Dr. Stewart says: “Sacral neuromodulation can be a game-changer for patients with refractory overactive bladder or urge incontinence. The ability to test the therapy before committing to the implant is a significant advantage.”
2. Percutaneous Tibial Nerve Stimulation (PTNS)
PTNS is a non-surgical, office-based treatment that stimulates the tibial nerve near the ankle to improve bladder control.
Key Features:
- No surgery required
- Typically involves 12 weekly 30-minute sessions performed in the office, followed by maintenance treatments
- Can be effective for overactive bladder and urge incontinence
- Minimal side effects, low risk.
Available Systems:
- Medtronic NURO™ System
- Laborie Urgent® PC
Dr. Stewart says: “PTNS is an excellent option for patients who want to try neuromodulation without surgery. It requires a time commitment for the treatments, but many patients find significant relief with minimal risk.”
3. Implanted Tibial Nerve Stimulation
This newer form of neuromodulation involves a small implanted device that stimulates the tibial nerve, offering a long-term solution without the need for weekly office visits.
Key Features:
- Minimally invasive procedure to implant the device
- Provides ongoing stimulation without frequent office visits
- Can be effective for overactive bladder symptoms
- Rechargeable and non-rechargeable options available
Available Systems:
- BlueWind Revi™ System
- Valencia Technologies eCoin®
Dr. Stewart says: “Implanted tibial nerve stimulation offers an interesting middle ground between PTNS and sacral neuromodulation. It provides continuous therapy like SNM but with a less invasive procedure. It’s an exciting new option in our neuromodulation toolkit.”
Choosing the Right Neuromodulation Therapy
The choice between these neuromodulation therapies depends on various factors, including:
- Severity and type of incontinence
- Patient preferences regarding surgery and ongoing management
- Response to previous treatments
- Overall health and medical history
We’ll work together to determine which neuromodulation approach, if any, is best suited for your individual situation. Each type of therapy has its own benefits and considerations, and what works best can vary from patient to patient.
Remember, neuromodulation therapies are typically considered after more conservative treatments have been tried without satisfactory results. They offer hope for many patients who have struggled to find relief from their bladder control issues.