March 4, 2009 – A new surgically implanted electrical device that stimulates the sacral nerve may be an alternative to transvaginal placement of surgical mesh to treat urinary incontinence.

The device is called InterStim and is sold by medical device manufacturing giant Medtronic Inc. It is implanted during a half-hour surgery, which can be done using local anesthetic with a sedative or under general anesthesia. The cost, generally from $20,000 to $30,000, is covered by most insurers. InterStim is meant to be left on continuously, but patients can use a remote control to turn it on and off and adjust intensity. When the device is on, it feels like a slight vibration or tingling. There are two available models, and the newer one offers four preset programs.

InterStim works by delivering a mild electrical pulse to stimulate a nerve, located near the base of the spine, involved in controlling bladder function. Exactly how neurostimulation works isn’t fully understood. However, doctors believe that at least one of the ways it works is by blocking abnormal information sent from the bladder to nerves.

According to physicians, sacral neural stimulation works well for many patients suffering from incontinence, but it is not for everyone. Consequently, doctors recommend that patients first wear the device externally for a one-week trial period before being implanted with it.

In 2006, a study published in the Journal of Urology, which was funded by Scottish and British health authorities, concluded that sacral nerve stimulation using the InterStim device works well for urge incontinence. Overall, in the four randomized, controlled trials reviewed by the authors, 80% of 120 patients showed at least a 50% improvement (which physicians consider the threshold for making the procedure worthwhile).

Unfortunately, the study also found that 33% of patients needed to be operated on again, typically because of infection and pain. But, according to Steven Siegel, a St. Paul, Minnesota, urologist and an investigator on a major Medtronic-funded trial of InterStim, the percentage of repeat surgeries has decreased in recent years due to improved equipment and techniques.

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Published November 17, 2011 by