Bladder Pacemaker - A new breakthrough available locally

Bladder control is an embarrassing problem that most people don't want to talk about.

It's uncomfortable to have to run to the bathroom all the time, and inconvenient to have to stay at home in order to avoid an "accident."

In this special Medical Moment, we look at an outpatient procedure that has people on the go again.



Part One: An Introduction
Wednesday, April 29, 2009

Seventy-one-year-old Marlin Milligan owns his own realty company and doesn't have time to worry about where the closest bathroom is, or whether he'll have an embarrassing accident in front of family and friends.

"I have a problem -- I guess they call it a leaking problem -- and it's very uncomfortable," Marlin explains.

His urologist, Doctor Carl Walker, has had Marlin try medication, which seemed to help for a while.

"Basically, he has to go to the bathroom ten times -- at least -- a day and gets up several times at night," Dr. Walker explains. "Currently, when he gets the urge to go, it's too late. He has to rush there and he'll wet on the way there."

Marlin scheduled an appointment with Dr. Walker for a test to determine whether he would be a good candidate for what's called InterStim Therapy, which is basically a pacemaker for the bladder.

The test is done right in the office, after an injection that numbs the area.

"We're going to place a thin wire called a lead near his tailbone to stimulate the nerve that goes to the bladder and allows the bladder to function properly," Dr. Walker explains.

He will put temporary lead wires on each side of Marlin's backside.

"Basically, it's like putting an IV in. It's really no more invasive than that," Dr. Walker says. "Nothing is going deep. I always emphasize nothing's in the actual spinal cord -- a lot of people get nervous about that. This is just in the tailbone area."

It takes about ten minutes for the doctor to find the exact spot where he wants to place the leads. He will then do the same thing on the other side.

Then the leads are attached to a temporary external battery pack and tested.

Marlin will go home and alternate testing the leads to see which side gives him the most relief.

"He'll be able to either turn the battery off or turn it on and adjust the setting so that he feels a little bit of stimulation," Dr. Walker says. "With this stimulation, he should be able to get to the bathroom with more time, have a little bit more warning time to get to the bathroom, and when he goes the plan is for him to be able to empty out completely."

Best of all, Marlin reports that he didn't experience any pain while using the device.

After a follow-up visit, Dr. Walker decided that Marlin was ready for the permanent implant.




Part Two: The Procedure and Results
Thursday, April 30, 2009

On the morning of his surgery, Marlin arrives at Memorial Hospital and has one last meeting with Dr. Walker. He will undergo an outpatient procedure in which a permanent lead wire will be attached, and a battery will be implanted.

Marlin will be awake for the procedure, but the doctor gives him medication so that he won't feel any pain.

While watching x-rays, Dr. Walker frames the spot where he wants the permanent leads to go.

"This is going through that S3 opening that we talked about. This needle has found that space and we can confirm that on the x-ray here," he demonstrates.

The permanent lead will be hooked up to the pacemaker-like battery, which itself will be placed right under the skin on Marlin's backside.

"We're going to send stimulation with electrical impulses through that lead, and that's going to activate the bladder -- in this gentleman's case -- not to be overactive," Dr. Walker explains.

Marlin is awake so that doctors can watch for movement.

"That S3 nerve also allows for contraction of the big toe, and that's how we know we've got the proper motor response from the nerve that we're stimulating," Dr. Walker explains.

Confident that he is in the right spot, it's time for the permanent lead.

"This is what's going to stay in the body," Dr. Walker explains. "We're going to tunnel it down to the area where the needle was initially, and the end of this lead here will be connected to the battery unit."

Dr. Walker and his staff test the lead with a little stimulation. Satisfied, they attach the lead to the battery.

After numbing the area, the battery pack is completely implanted in Marlin's backside.

Less than an hour after the procedure began, Dr. Walker stitches up Marlin's only incision.

"Everything went great. No problems," Dr. Walker says confidently.

A groggy Marlin is wheeled back to his room where his wife gets the news that all went well.

"I don't feel anything now, except just a little bit of a soreness right here where the implant [is]. I feel fine," he reveals.

We checked in with Marlin at his office just a month later and talked with him about life before InterStim Therapy.

"I couldn't go out and cut grass even. Anytime I was doing anything that was physical, then I would have leakage problems," he explains.

And now?

"I know that I've got time when I feel that I have to relieve myself," Marlin says happily. "I feel fantastic."

Fantastic enough to be back at work full-time and accident-free.




Additional Links

For more information about InterStim Therapy, visit www.interstim.com

To read more about Dr. Walker or to find his contact information, visit http://www.southbendclinic.com/physicians.aspx?id=118


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