BackTable / Urology / Article

Electric Stimulation for Overactive Bladder: Patient Evaluation, Device Selection & Complications

Author Ishaan Sangwan covers Electric Stimulation for Overactive Bladder: Patient Evaluation, Device Selection & Complications on BackTable Urology

Ishaan Sangwan • Jan 15, 2022 • 33 hits

Electrical stimulation of the sacral nerve can help ease symptoms of overactive bladder. These procedures are minimally invasive, and are a great option for patients who want to have control over their symptoms. Urologist Dr. Daniel Hoffman covers evaluation of a patient for electric neurostimulation, considerations for device selection, and possible complications in his conversation with Dr. Jose Silva on the BackTable Urology Podcast. We’ve provided the highlight reel in this article, and you can listen to the full podcast below.

The BackTable Urology Brief

• Patients can try out electrical stimulation for overactive bladder by undergoing a percutaneous nerve evaluation, which lets them try the therapy for 3-5 days before committing.

• If a patient is unable to recharge their device in• a timely manner, a battery operated device may be preferable. Otherwise, they can try a rechargeable device.

• Device reprogramming and lead revisions can be performed if the patient experiences pain from the device.

• If a battery revision is indicated, the lead may need to be replaced as well, since leads are not compatible across different brands and battery types.

A backtable set up for sacral neurostimulation procedure.

Table of Contents

(1) Evaluation for Electric Neurostimulation in Overactive Bladder Patients

(2) Device Selection for Electric Neurostimulation in Overactive Bladder Patients

(3) Complication of Electric Neurostimulation in Overactive Bladder Patients

Evaluation for Electric Neurostimulation in Overactive Bladder Patients

Evaluation of a patient for electric neurostimulation can be done through a staged approach, letting the patient try the therapy before making a commitment to it. A percutaneous nerve evaluation is a 15 to 20 minute procedure, after which the patient wears a device for 3 to 5 days before making a choice. If a patient is catheter dependent, they need to either learn catheterization, or have a suprapubic tube inserted before a peripheral nerve evaluation (PNE) can be performed. Overall, however, these devices work well because they let patients have control over their symptoms.

[Dr. Daniel Hoffman]
Well, again, you know, I like the patients in retention for neurostimulation. I think the patients in nonobstructive retention do really well. but for me again, it's all about what the patient wants. And once you start talking about neurostimulation and how it works, most patients tend to select that pathway.

I think that when you talk about a staged approach where you can actually take the therapy out on a test drive and get a sense of whether it works for you or not, before you have to make a commitment to that therapy. I think a lot of people buy into that. And at least in my practice, I do a lot of percutaneous nerve evaluations.

So you come in for a 15 to 20 minute procedure, you wear the device for three to five days, and then you can make a decision as to whether that's right for you or not. And if it's not right for you, then we can talk about Botox or tibial nerve modulation. But I think tibial nerve modulation and sacral neuromodulation are flip sides of the same coin.

[Dr. Jose Silva]
So for a patient that has a Foley catheter, are you doing a PNE or are you doing a stage one for those patients?

[Dr. Daniel Hoffman]
If they're catheter dependent, then we have to get them out of that state. So I learned that one the hard way too. You either need to put a suprapubic tube in them or you need to teach them CIC. If they're in retention, I'll go in, I'll put it in, and if they refuse to learn catheterization, I'll put a suprapubic tube in and then I'll do a stage approach for that patient in particular. Because when they're in chronic retention like that, it takes them a little longer for the bladder to get going. It's not going to be that three-to-five day PNE that's going to jumpstart their bladder.

So for that patient, a staged approach is often a little better, but for your frequency urgency, and I don't know if you see it in your practice, but my overactive bladder patients are coming in younger and younger. And those patients do really well with neuromodulation because they understand that it's a device, it's something they can control. It's something they can recharge, and it puts them in the driver's seat of their symptoms.

Listen to the Full Podcast

Advanced Treatments for Overactive Bladder (OAB) with Dr. Daniel Hoffman on the BackTable Urology Podcast)
Ep 20 Advanced Treatments for Overactive Bladder (OAB) with Dr. Daniel Hoffman
00:00 / 01:04

Earn CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs.
Follow the button below to get started with CMEfy.

BackTable CMEfy button

Stay Up To Date

Follow:

Subscribe:

Sign Up:

Device Selection for Electric Neurostimulation in Overactive Bladder Patients

The two major nerve stimulator devices are the Medtronic and Axonics devices. According to Dr. Hoffman, the biggest consideration between these devices is the type of battery. Axonics is the only primary cell device on the market, and is therefore recommended for a patient who may forget to recharge their device or is otherwise unable to recharge their device. The Medtronic device may be more suitable for younger patients who are able to maintain the device.

[Dr. Jose Silva]
Danny, so let let's talk about nerve stimulators. So for overactivity or voiding dysfunction, botox and nerve stimulator are the tools that you use, including the Medtronic and the Axonics devices. You use both. Any difference?

[Dr. Daniel Hoffman]
I use both. So, you know, we could go down the rabbit hole of constant current and direct current. That's not a conversation that I think is within our scope. I think that as long as the energy is being delivered and you put the lead in the right place, the therapies are relatively equivalent. I’ve found that not everyone is a candidate for a rechargeable device, and Axonics still has the only primary cell on the market.

[Dr. Jose Silva]
You found out the hard way.

[Dr. Daniel Hoffman]
It's true though. You have to think about that because you don't want to put the burden of recharging on the caretaker. And if that does become a burden, they're not going to recharge it. They're not going to get the therapy into that patient. Go with a battery operated device.

Complication of Electric Neurostimulation in Overactive Bladder Patients

Pain is the most common complication of electric neurostimulation therapy. The easiest solution to this is reprogramming the device to get the arc of the energy further away from S4 and towards S3. Lead revisions and battery revisions can also be performed if this does not work. If a battery revision is performed to switch to a battery operated or rechargeable device, it is important to note that the lead must also be swapped, because the lead is not interchangeable.

[Dr. Jose Silva]
Let's talk about some complications. Some patients complain of chronic pain, chronic pain down the leg. Do you try to replace the device, or what do you do with those patients?

[Dr. Daniel Hoffman]
If they're having pain down the leg, the first thing I do is reprogram. I try to get the arc of the energy, as far away from S4 as possible. So you try to bring it up closer to S3. And usually if you're getting referred pain down the leg, it's because you're getting closer to four. The patient that doesn't do well with a reprogram, I would consider lead revision and I’m not hesitant to do a lead revision on a patient. I think that the patient that has pain at the stimulator site can be a little bit more challenging. Sometimes you have to do battery revisions or with generator revisions, get it a little deeper if it's too superficial…

[Dr. Jose Silva]
Have you used the recharger of the Medtronic device?

[Dr. Daniel Hoffman]
I have, and I've had some patients come in with a dead primary cell and they want to upgrade to a rechargeable device or an MRI compatible device. And do they want to stick with Medtronic? And we absolutely go down that pathway.

[Dr. Jose Silva]
You don't need to change the lead, right. I mean, as long as the lead was MRI compatible.

[Dr. Daniel Hoffman]
That's the catch, right? So the primary cell is where the things that were not MRI compatible were, the lead was MRI compatible, but the lead is not interchangeable. So if you're going to go from primary cell to rechargeability, you've got to do a full swap. If you're just going to put in an MRI compliant primary cell, you can keep the same lead.

Podcast Contributors

Dr. Daniel Hoffman discusses Advanced Treatments for Overactive Bladder (OAB) on the BackTable 20 Podcast

Dr. Daniel Hoffman

Dr. Daniel Hoffman is a practicing urologist with AdventHealth in Orlando, Florida.

Dr. Jose Silva discusses Advanced Treatments for Overactive Bladder (OAB) on the BackTable 20 Podcast

Dr. Jose Silva

Dr. Jose Silva is a board certified urologist practicing in Central Florida.

Cite This Podcast

BackTable, LLC (Producer). (2021, October 27). Ep. 20 – Advanced Treatments for Overactive Bladder (OAB) [Audio podcast]. Retrieved from https://www.backtable.com

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

Earn CME When You Listen to BackTable CMEfy

Podcasts

Advanced Treatments for Overactive Bladder (OAB) with Dr. Daniel Hoffman on the BackTable Urology Podcast)

Articles

Topics

Overactive Bladder Condition Overview

Get in touch!

We want to hear from you. Let us know if you’re interested in partnering with BackTable as a Podcast guest, a sponsor, or as a member of the BackTable Team.

Select which show(s) you would like to subcribe to:

Thanks! Message sent.