WHAT IS THE ULTIMATE TREATMENT FOR OVERACTIVE BLADDER | PACEMAKER FOR OVERACTIVE BLADDER:

 

Overactive bladder means frequent urination or passing urine more than eight times a day, waking up at night to pass urine more than twice, and cannot reach the washroom in time occasionally and having a mishap. If you have an overactive bladder and you have tried your best to overcome this situation, you have consulted your specialist doctor, you have restricted all bladder irritant foods and drinks, you have dealt with your irregular bowels and taken all possible medicines but nothing proved successful. Now, is there any other remedy for this situation? In this article, we shall discuss bladder pacemaker implants which could assist patients with such symptoms. We shall discuss the real course of action, how it is done and the side effects that you may come across after the implant is done. 

A bladder pacemaker also called sacral neuromodulation is a treatment used to help many patients with bladder control problems and who do not respond to behavioral and pharmacological therapy. It is a safe, efficacious and minimally invasive advanced therapy indicated to treat urinary incontinence, urinary retention, urgency, frequency, and fecal incontinence. There are sacral nerves that control the muscles in the pelvic floor, the bladder, and the muscles needed for urinary control. A bladder pacemaker balances the performance of the bladder by triggering the sacral nerve root going down the bladder.  

In this case, clinical success is defined if the symptoms of overactive bladder achieve progress by fifty percent. Overactive bladder is defined by the following four indications. One is the urinary frequency which means frequently going to the toilet to pass urine; urinary urgency means immediate and urgent need of going to the toilet to pass urine and it’s quite hard to stop or linger on; nocturia means to get up to pass urine in the middle of your night sleep while urinary incontinence means unintentional discharge of urine before reaching the toilet on feeling the sensation of passing urine. If we consider statistics concerning the successful implant of bladder pacemakers we come to know that clinical success has been achieved by eighty-three percent of patients within one year, seventy-six percent of patients within three years, and sixty-seven percent were successful on completion of five years of the implant. The statistics given here may not presumably contain the real figures and may be on the lower side because the individuals who left the survey were categorized as unsuccessful whether they did not come back for a re-examination of their implant or they shifted elsewhere and couldn't go on in the survey.  (@ chhanno blogspot com 01112021). 

Let’s discuss the working of a bladder pacemaker. Its implant is initially done for a trial for one or two weeks which is quite good due to the implant of a provisional wire or lead for one or two weeks in your back, very close to the nerve root. Your spine is kept away or at a small distance from this wire or implant and has no contact with this gadget. It simply goes very close to the nerve root. This is quite a thin wire and it’s the only wire that is implanted as a final one. That lead excites the nerve through its single contact point. One end of that lead is inserted inside of the body while its other end is connected to an outside battery. You have to wear that battery to remain there, out of your body. During the trial period, you have to wear the battery for seven to about fourteen days keeping in view the place from where your initial phase of surgery was performed. This initial phase of surgery may be done in some medical centers wherein local anesthesia is used meaning the area under surgery is numbed using a medicine locally. If you like this procedure can also be done in some OT. The anesthesia used in the OT is not so strong and does not make you completely snooze however you take a few more medicines to be somewhat more at ease during the surgery. At the same time, the wire is inserted through your back for a trial period which extends from seven to fourteen days as stated earlier. Following seven days or fourteen days you have the option to choose whether the condition of your overactive bladder has improved or otherwise and depending upon that assessment in case your condition has improved you may choose to go for the second procedure for the implant of second and last lead. 

There are four contact points in the second and final lead and it is accompanied by a programmable remote control through which each point can be stimulated separately or in the desired combination. With the help of this remote control, the best and desired stimulation can be detected easily. The pacemaker gets power from a battery which is available in two types that can be chosen as per your choice. One type of it cannot be recharged and is being used for a long time, most often for cardio pacemakers and others. Its efficient life span extends around 3 years to 5 years. The second type of battery is a rechargeable one and its size is nearly one-fourth of the first battery. The good thing is that it keeps working for as long as fifteen years after every seven days or so of regular recharging. A Velcro belt that contains a battery charger is required for you to wear. Whenever needed, you just have to push on a button on it and sit for around twenty minutes to fully charge it. Very simple and easy, and it also allows you to schedule how often you need to recharge it. 

 

Indeed, you will have some pain during and after the surgery. Although the feeling of pain depends on person to person basis however most of the patients consider it not a severe one. However, to add strength to the patients some light or sometimes a stronger painkiller may be helpful. Ordinarily, such medicines are sufficient for you since you have only minor cuts or incisions during this procedure. You have only one small cut for the lead position and another comparatively large cut sufficient to insert the battery beneath the skin. Batteries are manufactured mainly for implanting them beneath the skin. Therefore, the cut or procedure is exceptionally not much excruciating. 

Like all surgeries, there may also be some minor hazards in the procedure of pacemaker implant. For instance, the patient may catch some exceptionally rare infection, especially in a typical sterilized environment where this is done. In case some discharge oozes out from the cut and some inflammation or rosy tint is encircling the cut or such things it indicates an infection and if it happens you have to get the pacemaker device taken out which is again an incredibly rare case. Nearly twenty percent of the patients report uneasiness due to stimulation by the pacemaker which is quite a common response. This is so because its stimulation creates a humming or quivering feeling down there or in the bladder region. In case the stimulation is once in a while turned excessively high it tends to be painful or uneasy. Sometimes people also report uneasy feelings when the program of the device is modified. Such humming feelings are most commonly felt at the beginning when the program of the pacemaker is started but when you are accustomed to it you take it as something quite ordinary and do not feel it at all any longer. In nearly fifteen percent of the cases, people complain of some annoying pain in the implant site or the area where the battery is inserted. While this is truly irritating, however, physicians have certain methods and ways of assessing the pain and choosing if it is because of device stimulation or any other thing that is causing it. Your physician then coordinates with you to ensure find a solution for you to recover from pain.  (@ chhanno blogspot com 01112021). 

Finally, if we look at the statistics about the clinical effectiveness of this device and the patients who are not satisfied with it and complain that the bladder pacemaker is not giving the desired results anymore it has been found that such cases are nearly thirteen percent. Now, this is also a risk factor because although the device worked quite alright earlier it may quit working for you eventually. It happens because there are so many distinct reasons that can cause overactive bladder symptoms. 

 

This device has an additional feature that is quite fascinating. It can also be utilized for the treatment of non-obstructive urinary retention or experiencing it hard to pass urine despite there being no obstacle. Suppose you cannot pass urine easily and prostate enlargement is not the reason in male patients or a shorter sling narrowing urethra in ladies, this device can be helpful in such cases. Similarly, it is useful for fecal incontinence as well. Generally speaking, this is a magnificent device. Patients who have used this device are excited about their satisfaction. To succeed in your effort to control your urinary incontinence, please also go see a nearby urologist and ask about the use of this medical procedure and implant. In case you do not like to undergo surgery you may try more choices still there as well. For example, you have bladder Botox or posterior tibial nerve stimulation that resembles acupuncture therapy for bladder incontinence. 

OK, thank you so much. Take care everywhere and always.  

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 (Updated on 25-01-2023)