Advanced Therapies for Overactive Bladder

To you who are frustrated by the symptoms of an overactive bladder — frequency, urgency, racing to the restroom, leakage of stool — allow us to introduce you to the fast-paced world of advanced therapies. As authoritative voices in urology, the compassionate experts at St Pete Urology in beautiful St Petersburg, FL share the effective treatment options available for overactive bladder.

Dr. Nicholas Laryngakis and Dr. Reid Graves, board-certified urologists, are no strangers to the tribulations of bladder control. “Tonight, we’re going to talk about bowel and bladder control primarily,” Dr. Laryngakis begins, introducing our exploration of advanced therapies for this pervasive issue.

Going Beyond Pills – Expanding Treatment Horizons

The St Pete Urology team recognizes that some people are hesitant to take pills or find the side effects of current medications too challenging. For these people, there are three main topics to explore: the medtronic interstim system, the medtronic neuro tibial nerve stimulator, and injectable medications.

“Botox is an FDA-approved medication to treat overactive bladder frequency and urgency. It does not, however, treat fecal incontinence,” Dr. Graves explains. Botox injections — a “procedure that’s done sometimes in the office” — are a viable solution for many patients. This advanced therapy works by relaxing the bladder muscles to prevent overactive bladder symptoms. However, because its effects are temporary, patients may be required to undergo repeat treatments every six to twelve months.

The Medtronic InterStim System – A Long-Lasting Solution

“However, I think that if you have an option that can last for many, many years, and it’s one procedure, I think that’s where the Medtronic system sort of beats out Botox,” Dr. Graves continues, moving on to discuss the Medtronic InterStim System. This innovative therapy could be the solution for those seeking long-term relief.

This system consists of an implant that sends mild electrical pulses to the sacral nerves, effectively controlling the communication between the brain and the nerves related to bladder control. It also offers a crucial advantage: before you commit to the procedure, you can take an InterStim test. Under the care of the dynamic St Pete Urology team, this trial procedure is conducted right in the office, providing a glimpse into what overactive bladder relief could look like.

The Promise of Long-Term Relief

An overactive bladder can hamper the quality of life, but help is at hand at St Pete Urology in St Petersburg, FL. As Dr. Graves attests, “We actually do that in our office here, so you don’t need to be put to sleep. There’s an x-ray machine that comes in, and we actually do the procedure right here in the office in the comfort of the office and not have to go to a hospital or anything like that.”

The board-certified urologists in FL are committed to helping people regain control over their bladder, offering them the chance to reclaim their lives from the constant bathroom trips. So reach out today — your path to relief could begin right here in St Petersburg, FL.

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Transcription:

Dr. Nicholas Laryngakis (Board Certified Urologist):

Tonight, we’re going to talk about bowel and bladder control primarily. So Dr. Graves and I both actually trained together at the University of Pennsylvania in Philadelphia, and we’ve been each practicing for close to 10 years, and we’ve had five years of urology training in residency and med school before that. And the topic tonight is something that we do have a lot of focus in and enjoy taking care of and have specialty in. 

Dr. Reid Graves (Board Certified Urologist):

So then that goes on to the next step. Well, what if I have all these problems? What if I have overactive bladder frequency, urgency, racing to the bathroom, leakage of stool, and I don’t want to take a pill, or I’ve tried the pills and they have too many side effects? Well, there’s essentially three main topics that we’ll touch on here. There’s the medtronic interstim system, the medtronic neuro, which is a tibial nerve stimulator, which I’ll go over, and then injectable medications. 

It’s important to note that the medtronic interstim neuromodulation system, which is what we’re discussing tonight, mostly is the only one that really helps with control of the bladder and the bowel. So Botox is an FDA-approved medication to treat overactive bladder frequency and urgency. It does not, however, treat fecal incontinence, and it’s actually a procedure that’s done sometimes in the office, but oftentimes in a surgery center with a little bit of sedation. 

Sometimes a general anesthetic is needed, and essentially Botox is injected into the muscle of the bladder to relax the bladder to prevent the overactive bladder. And it really does work, however, it wears off by the nature of it. Essentially it’s a toxin, and that effect of it wears off, similar to the Botox that some people get in their foreheads, for example, it doesn’t last forever. And so that’s one of the downsides of it, is that you have to redo it, six to 12 months often gets repeated. 

And in addition to that, there are side effects that can kind of paralyze the bladder temporarily and require the need to catheterize. And it also has been linked to causing some urinary tract infections after the procedure. So for that reason, you know, up to 50% or so of patients will come off of that after a treatment or two, but it’s not harmful to try it. However, I think that if you have an option that can last for many, many years, and it’s one procedure, I think that’s where the Medtronic system sort of beats out Botox.

Some patients might be just a little reluctant to have the Medtronic Intersim system implanted. And so sometimes patients will want to try the PTNM, the percutaneous tibial nerve stimulator neuromodulation, and that’s a great option. We do it in the office. You come in, it takes about 30 minutes to get comfortable in the chair, and there’s essentially like an acupuncture needle that stimulates the tibial nerve, which actually tracks up and then modulates the bladder. 

So during that 30 minute session, it’s in the office, it’s once a week for 12 weeks, and after that, there are monthly maintenance sessions for long-term relief of the symptoms. And it does work. It’s amazing. And then lastly, the sacral neuromodulation Medtronic system. So there are two different types of systems. There’s the rechargeable and non-rechargeable, and that’ll always be a question of which is better, which should I use? Just that they’re both essentially put in the exact same way. 

The only difference is one of them you have to recharge and one of them you don’t. In terms of the battery, it used to be that the rechargeable battery was used more. It’s a little smaller and it lasts longer, but they’ve recently come out with an Intersim X, which is very new to be released. And that non-rechargeable battery is lasting for anywhere from 10 to even 15 years, which is amazing because essentially Medtronic started off as a battery company, and that’s what they’re good at, and that’s what they do. 

And to have a battery that can not have to be recharged for 10 to 15 years, that’s pretty amazing. So this system essentially is implanted under the skin and the upper buttock, and the lead goes and stimulates the sacral nerve. But before we go implanting it, we want to make sure it works. So what a lot of people, what everyone essentially does is they have an Intersim test. 

And that’s one of the things I love about Intersim is because if you’re not sure, you just do the test. And the test is done either in a surgery center or even just in the doctor’s office. We actually do that in our office here, so you don’t need to be put to sleep. There’s an x-ray machine that comes in and we actually do the procedure right here in the office in the comfort of the office and not have to go to a hospital or anything like that. The lead is put in the right spot, you wear an external device that is on for about three to five days, and you can see what it will be like if you were to have the Interstim implant.

And so you can actually see what your symptoms are like, and we monitor to make sure there’s a greater than 50% improvement in your symptoms. And if in fact you do notice a difference, then we can go ahead and schedule you for the implant, which essentially is very similar to the test. It’s just that we implant the battery under the skin so that you can keep it in and it’s permanent and it lasts for 10 to 15 years, and then we have to change the battery, which is very easy to do in the future if needed.