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Geoffrey Habermacher, MD, PhD
Urological Associates, Ltd
Geoff Habermacher, MD, completed his undergraduate work at Wake Forest University, received his PhD in Cell and Molecular Biology from Emory University and earned his medical degree at Emory University School of Medicine. He completed his urology residency at Northwestern Medical Center. His personal interests include tennis, military history and cooking.
Pacing Bladder Function
Sacral Neural Modulation
An estimated 33 million Americans suffer from bladder control problems and, as a result, often struggle with simple, everyday activities. InterStim® Therapyprovides a minimally invasive treatment option for addressing symptoms, such as urinary leaking, urgency and frequency, allowing individuals to experience an improved quality of life.
InterStim Therapy® is similar to a pacemaker for the bladder, which uses mild electrical pulses to target the communication problem that exists between the sacral nerves (near the tailbone that control the bladder) and the brain to tell the bladder to work correctly. Implantation of the InterStim device is an outpatient procedure that is performed by a surgeon and takes about 45 minutes.
Candidates for InterStim Therapy include women and men with severe nonobstructive bladder dysfunction that is not treated effectively with medicines or other conservative methods. Thankfully, many patients with bladder dysfunction will respond to anticholinergic medications that relax the bladder muscle (e.g., oxybutinin, Ditropan, Vesicare and Enablex). However, these medicines often cause side effects like dry mouth, constipation, blurry vision and impaired cognition. Thus, many patients stop taking the medicines due to these issues. Until recently, no other treatment options existed for patients who were medication nonresponders or who could not tolerate the medicines due to side effects. This is where InterStim Therapy helps patients.
InterStim Therapy has been an FDA approved therapy for bladder dysfunction for approximately 14 years. Some technical aspects of the implantation process and the hardware have changed since the initial implants but the fundamentals have not. Most of the nerves that control the bladder transit through the part of the bony pelvis called the sacrum. The sacral nerves are large bundles of nerves that innervate a variety of structures, including the bladder, rectum and legs. The S3 portion of the sacral nerves is primarily involved with the bladder, and this is what InterStim Therapy targets. The S3 nerve bundle is located behind the right and left S3 foramen in the bony sacrum. This is the bony landmark that allows for proper placement of the InterStim device. Once in place, the InterStim device lays next to the S3 nerve bundle and emits continuous pulses of electrical energy. Presumably, these electrical pulses alter some abnormal nerve signals being sent to the bladder that are causing the underlying bladder dysfunction.
Studies have shown that InterStim Therapy has a 70% to 80% success rate in patients who have bladder dysfunction that is unresponsive to conservative therapies (medicines, biofeedback, dietary modification, etc.). Also, InterStim is minimally invasive and fully reversible. Lastly, the device is entirely beneath the skin and soft tissues of the upper buttock, which makes it well tolerated and cosmetically pleasing.
Thus, many patients with severe bladder dysfunction who previously had no viable treatment options are being helped by this device.