RESUMO
Sacral nerve neuromodulation is accepted technology for patients with refractory urge incontinence, urinary frequency syndrome, and chronic urinary retention. This treatment consists of an implantable lead and neurostimulator (battery) using light electrical pulses to stimulate the sacral nerve controlling the bladder and other muscles that control urinary function. This article reviews the indications for neuromodulation as well as patient selection and testing phases associated with this technology.
Assuntos
Terapia por Estimulação Elétrica/métodos , Próteses e Implantes , Sacro/inervação , Transtornos Urinários/terapia , Tomada de Decisões , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Humanos , Seleção de PacientesRESUMO
While it is not critical for health care providers to know everything about the InterStim (sacral nerve neuromodulation) equipment and programming, Part II of this series will increase the provider's knowledge about InterStim therapy by describing the equipment, delineating patient education needs, and discussing the art of programming. This article will assist the provider in trouble shooting the system and provide some insight into the patient's therapy.
Assuntos
Terapia por Estimulação Elétrica/instrumentação , Próteses e Implantes , Sacro/inervação , Software , Transtornos Urinários/terapia , Eletrodos Implantados , Humanos , Educação de Pacientes como AssuntoRESUMO
Part III of this sacral nerve neuromodulation (InterStim therapy) series describes two case studies. This article coalesces all the concepts associated with InterStim therapy, including criteria for patient selection, education, surgery, programming, and return visits. The first case study describes a woman with urgency-frequency and urinary incontinence. The second case study discusses a woman with a diagnosis of urinary retention. These case studies provide the reader with successful outcomes with InterStim and its use as a viable treatment option when patients meet the selection criteria.
Assuntos
Terapia por Estimulação Elétrica , Implantação de Prótese , Sacro/inervação , Incontinência Urinária/terapia , Retenção Urinária/terapia , Adulto , Idoso , Terapia por Estimulação Elétrica/efeitos adversos , Eletrodos Implantados , Feminino , Humanos , Dor/etiologia , Implantação de Prótese/efeitos adversos , Incontinência Urinária/diagnóstico , Retenção Urinária/diagnóstico , UrodinâmicaRESUMO
OBJECTIVES: To describe a strategy for revising the malfunctioning InterStim device and to provide an algorithm for evaluation and management. METHODS: We retrospectively reviewed 82 patients who had undergone InterStim placement. Ten patients (eight women and two men) experienced complications and subsequently underwent revision of their device between October 2001 and October 2003. Five patients had originally received a permanent implant after a successful percutaneous test stimulation trial, and five had undergone a test stimulation using the tined lead. Indications for revision included gradual onset of recurrent voiding dysfunction (n = 2), lead migration (n = 5), generator malfunction (n = 1), generator site pain and infection (n = 1), and genital/rectal pain with stimulation (sensory discomfort; n = 1). RESULTS: Of the 10 patients who underwent revision, 7 experienced complete resolution of their problem. Eight patients had lead site changes and two had generator replacements. No intraoperative or postoperative complications occurred in the revision cases. CONCLUSIONS: In our experience, 70% of patients who undergo revision of the malfunctioning InterStim can expect success. In this study, no difference in success appeared to be related to the original cause of malfunction. In the management of malfunctioning sacral neuromodulators, we recommend an attempt at revision before permanent explantation.
