September 2011
E. JAKE JACOBO, M.D., FACS
UROLOGY CONSULTANTS
LONGWOOD - WINTER
PARK, FLORIDA
(407) 332-0777
The world literature is filled with various devices and trials of multiple
drugs for the management of overactive bladder and the so called painful bladder syndrome. There was a time when when individuals
tried different overactive bladder medications and the responses were not what they expected, which is freedom of sanitary
napkins, absorbents, Depends® and drugs. This is a miserable condition, affecting the quality of life of many, there are
the pills (many of them), the gels, the tibia stimulation, the bio-feedback, vaginal cones and many bladder control exercises.
They are all good, when they work!!
I am writing about the patient who has reached the end of the road, when hope is
almost gone and their budget for sanitary napkins and absorbents continues to escalate and they are still wet. I first became
acquainted with the Interstim® system about 10 years ago, I've learned during the last four decades of active practice
to allow the "tincture of time" tell me if something is really that effective. Most devices go through a natural
curve of improvement before they can proclaim its true effectiveness, many die in the process and just disappear. The Interstim®
is a unique exception--this baby has reached a unique level of maturity. This month (September/2011) marks the 100,000 Interstim®
implanted device and as such it deserves respect. My oldest implanted patient is 95 years old with a young wife, his quality
of life was impaired by continued trips to urinate with urgency enough to have incontinence--plenty of it! He was embarrassed
to leave the house or go to public places, he became withdrawn, isolated and a hermit--not anymore, we have in our practice
many satisfied patients. I am writing to set the record straight from what I've read in the internet which is plagued with
negative experiences that are far from the norm. Perhaps the anecdotal reports relate to the earlier devices, who knows. This
device also received FDA approval just this year for cases of fecal incontinence. I am not going to go into the details of
the Interstim®, you can read about it at Medtronic.com, I just wish to leave you with one thought. When hope is vanishing, when there are no results with pills, gels and the various
treatments, why not subject yourself to a 20 minute test with local anesthesia (in the doctors office) for the placement of
the wire that stimulates the nerve(s) which control the bladder and see if this might be the answer for you?
You don't
need a statistician to tell you if it works. You will know in a few hours, perhaps a day or two to re-confirm that "its
not in your mind". If it works you will be anxiously waiting to be set up for the permanent interstim® device, another
outpatient procedure with local anesthesia and sedation. If it doesn't work, the wire comes out (my nurse removes it) and
that's it. The test in my office consists on a small syringe with local anesthesia, placement of the wire with x ray control
into the nerve that stimulates the bladder and sending you with a pencil and paper to keep track of your voiding diary together
with an outside generator (about the size of a beeper) that clips into your belt or side pocket. My patients, the ones which
qualify for this test, have reached a point that I call---End Stage Overactive Bladder--not much works for them and their
Depends® expenses sometimes exceeds that of their fun and play money. I have yet to find a patient in whom the insurance
company refused the initial test. We document everything and send the insurance reviewers extensive clinical notes and test
results to support our request.
A majority of my patients come from other urology or gynecology practices, looking
for hope when hope is almost gone. There are many urologist and gynecologist trained and qualified for Interstim® placement.
Give hope a chance, it might change your life with less change of garments.
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