Urinary Incontinence and the Robot
By Marja Sprock, M.D.

There has been a lot of talk about robots in medicine over the last few years. Is there any magic robot that can solve urinary incontinence?

Currently there is robotic surgery which is very similar to laparoscopic surgery (small incisions are made in the abdomen and instruments used through them.) The treatment for overactive bladder is non-surgical usually, therefore the robot as we know it in the operating room, will not be of any use.

However there is a device, smaller than a matchbox, and definitely smaller than a pen, that can give the impression of having a robot controlling your bladder for you.

A week after implantation of her little "robotic" device, my patient returned for a follow up visit. The first thing she asked me was: "why doesn't everybody have an implant like this? I am normal again, I have my dignity again, I played golf without bathroom breaks. I can not begin to tell you how happy I am with my implant."

Another patient had overactive bladder and had failed every other treatment except for the Interstim device, our little "robotic/magic" device. Like a lot of patients she was hesitant about an implant." I am not sure if I really want something inserted just above my buttock", she said. "I know it is like a pacemaker for the bladder, but I'll wait." She came back after a month: "this is no life, the overactive bladder rules my life, I'll try it." This same patient, who had been so hesitant, has sent me numerous of her girl friends to have the Interstim device implanted. She absolutely loves it and like my other patient, thinks "everybody should have one."

The Interstim stimulates the third Sacral nerve, a nerve that has a lot to do with urine and bowel control. It can cause tremendous improvement for patients with urinary urgency and frequency as well as urinary incontinence and retention. It also will help some people with fecal incontinence, however implantation for this indication is awaiting FDA approval. The Interstim will intermittently give a small impulse to the nerve, that when you focus on it can be felt in the vagina. Obviously you are not "being shocked" the whole day. You only feel it by really focusing on it.

Another misunderstanding is that you would have to change settings or press buttons. It is all programmed and if it works fine, no change is necessary.

The Interstim is for people who have failed numerous other treatments and is definitely not the first treatment.

The advantage of the Interstim is that you can "test-drive" it. A temporary stimulator can be inserted in the clinic under local anesthesia and can be tried for a week. After a week of trying, it is removed in less than a minute and then it can be decided if it is the right solution. Even the regular Interstim device implantation requires only local anesthesia and possibly some slight sedation if desired and is inserted in a hospital.
If you call it your "bladder pacemaker, little robot, or Interstim", does not matter, it can definitely improve your quality of life.

Even though for a lot of patients the Interstim device has been proven to be their magic robot, it is not the first step to treat overactive bladder.

If bothered by an urgency to go, losing urine before getting to the bathroom and frequency of urination, the first step is pelvic muscle control and nerve stimulation. For starters this can have a tremendously positive effect, and is not the same as "I have tried Kegel exercises at home".

Central Florida UroGynecology, in Rockledge, has a personalized computer enhanced, biofeedback program to teach you how to control and contract your muscles as well as some passive stimulation of the muscles and nerve. Medications can aid and add to the treatment of overactive bladder, but the muscle training should usually come first. Tibial nerve stimulation, which indirectly also works on the nerves controlling the bladder, is a next step up and is non-permanent nerve stimulation. This was recently covered by Medicare again.

The Interstim device, "your bladder pacemaker, little robot", is a permanent device. If your overactive bladder is so severe that it rules your life and you have tried other treatments, you may want to listen to my patients who wonder why: "everybody does not have a device implanted?" The short answer is : not everybody will need one. However for some people it will be a life saver.

A robot for overactive bladder? No not really, but we have come really close and definitely should not be scared of them.

Marja Sprock, MD is a fellowship trained urogynecologist who will be able to assist you in the best choice of treatment for your bladder, bowel or vaginal prolapse problems. Also your specialist for cosmetic vaginal surgery.

Call our Rockledge office at 321-806-3929, send us a note or visit us online at www.CFUroGyn.com.