Urology

Urological Program

BRTT Program: Neuromodulation for the treatment of Urge Incontinence
SCI Bladder & Bowel Program

BRTT Team

• Dr. Raymond Rackley, CCF
• Dr. Graham Creasey, VA & MHMC
• Dr. Ken Gustafson, Case & VA

BRTT Corporate Partner: NDI Medical Inc.

Project Description

Urge incontinence is a common disorder involving urinary frequency, urgency, and involuntary leakage. Urge incontinence, also known as overactive bladder (OAB), is characterized by a strong desire to urinate, followed by involuntary contractions of the bladder resulting in quick release of urine. Urge incontinence can be caused by infections, sphincter disorders or nervous system disorders that affect the bladder. The incidence of incontinence increases with age, affecting up to 35% of community-dwelling individuals age 60 and older.

Approximately 13 million Americans suffer from urinary incontinence and 8.4 million of those have urge or mixed (urge and stress) incontinence. The annual direct cost of urinary incontinence in the United States (in 1995 dollars) is estimated at $16.2 billion. The categories of treatment that are most widely available are behavioral, surgical, or pharmacological therapy. These treatments can be emotionally devastating and often result in less than satisfactory outcomes [Wilson, et al. 2001]. According to the National Association for Incontinence (1998), more than 64% of patients are dissatisfied with their treatments.

Pelvic neuromodulation is an emerging field that addresses bladder dysfunction including urinary incontinence. The only commercially available neuromodulation product for urinary incontinence is the Medtronic Interstim™ System, FDA approved in 1997. The Interstim System uses a two-stage procedure to place an electrode in contact with one a sacral nerve as it passes through the sacrum, and connect to an implanted pulse generator. Less than 50% of patients who undergo test stimulation for the Interstim System ultimately have a successful outcome [Schmidt, 1999]. We hypothesize that patients are unsuccessful with the Interstim device because of the location of the sacral nerve electrode. We are proposing to develop a novel approach using electrical stimulation to treat urinary urge incontinence by stimulating with specificity a purely sensory nerve located in the pelvis that has a consistent inhibitory effect on unwanted bladder contractions.