Overactive Bladder Surgery
Overactive bladder (OAB) is a condition that can quite easily consume your life. As common as it is, combating it with the treatments and medication sometimes does little to stop it. Making it a priority in one’s life may be time-consuming, but worth pursuing. In this article, we will go over overactive bladder surgery, so you can weigh your options in a more informed manner with your doctor.
Once diagnosed with OAB, your doctor will start you on a treatment journey. Treatments widely vary and take time to fully take effect before ruling out.
Wherever you stand in your journey, do not lose hope. There are advanced ways of calming your overactive bladder, two being medical procedures and surgeries for OAB.
1. Botox Injections for Overactive Bladder
As with any illness or condition, there are specific milestones in your treatment journey your doctor is going to want to hit before moving on to more intense therapy. One of the first therapies that your doctor will refer you to a urologist for is Botox injections in your bladder wall.
It might sound rather strange, but Botox is a muscle relaxant, which means its sole purpose is to relax overstimulated muscles. This works in the face, in areas of chronic pain and in areas of overactivity in the muscles.
What's the Procedure Like?
Your urologist will start by numbing your bladder with anesthetic. Most procedures are done in a day surgery clinic and require only local anesthetic. However, some patients require being put under general anesthetic to avoid any pain and discomfort.
Your urologist will insert a camera and a needle up your urethra into your bladder. Then, a series of about 20 injections are administered into your bladder wall. Depending on the severity of OAB, your urologist will choose between 100cc and 200ccs of Botox.
With any luck, you will see your OAB symptoms decrease anywhere from instantly to four weeks after the treatment. This treatment is a safe alternative to surgery and can last anywhere from six to nine months.
There is no limit to how many treatments you can have, although it is recommended to not have more than two within a span of three months to allow the treatment to take effect.
2. Sacral Nerve Stimulation for Overactive Bladder
Another viable option for OAB is sacral neuromodulation. This requires minor surgery.
To qualify as a candidate for this surgery, you must have shown no improvement on medications, pelvic floor retraining and Botox injections. This surgery is an option for people whose OAB is resistant to those therapies. It still requires a test procedure to see if the surgery is right for you.
The trial procedure is relatively easy to do. With you awake on the table, your urologist will insert a camera and a stimulant lead into a small incision in your skin through your tailbone far enough to reach your sacral nerves. They will elicit responses from the stim which might reflect as your toes curling and contracting. Your doctor may ask where you feel the stimulation. Once they find a spot to leave it, they tape it to your body and ask you to monitor your bladder habits for a few days to a week.
If your symptoms are not 50% better or more, they cannot perform surgery on you, as you do not fit the criteria. It does not improve much with the actual implant of the InterStim.
The Implant That Works Wonders
With patients who do have successful trial periods, surgery is booked. Your urological surgeon will make an incision in the buttock and implant a battery pack that will provide stimulation.
The stim lead is placed on your sacral nerves and attached to the InterStim battery. When you wake up from surgery, you will have some pain on your rear, but overall recovery takes about two weeks.
With the months and years after your surgery, you will require reprogramming with your InterStim. Adjustments made to the implant are to find the right setting and improve your compatibility with it.
The lead on your sacral nerve has four sections that stimulate. These are what can be adjusted with your doctor or a Medtronic representative.
With each setting adjustment, you have four to choose from on your handheld device, and you can increase and decrease the sensitivity on it (sort of like a TV remote that changes the station and the volume).
The InterStim batteries last around 10 years before you will need a replacement, so this surgery should not require a revision any time soon. If your first surgery is not a success, a revision surgery may be necessary to make the stimulation work for you and your OAB.
3. Bladder Augmentation for Overactive Bladder
Bladder augmentation is usually the last resort when finding solutions for OAB. This is major surgery and it requires a complete size adjustment of your bladder and is irreversible.
For the bladder augmentation surgery, they start by cutting open the top of the bladder, opening it up like a clam. Then, they remove a large section of the intestine of the GI tract, open the GI tract and place it on top of the bladder to increase its holding capacity.
It is usually successful in that it stops overactivity of the bladder, but about 80% of patients who receive this surgery have no feeling left in their bladder at all. They do not receive signals to the brain of having to urinate.
This surgery is not usually approved for younger patients, as this is a last resort, and you may have to cath to urinate for the rest of your life. It benefits the patient by swapping an overactive bladder or painful bladder experience for no overactivity and the chance to decide when they need to pee.
There are many medical advancements of dealing with OAB that range from small changes to extreme changes. This allows us to try many ways of managing our OAB.
For those of us who have had no luck with medication and procedures, there are overactive bladder surgery options out there, along with new research and ways of coping.
There are pros and cons with overactive bladder surgery, but hopefully we can find one or two solutions that help calm our OAB, and we have the knowledge to make an informed decision.