Interstim Therapy

[KDK513]

Has anyone tried this implant from Medtronic which provides electrical stimulation to the bladder? Eight months post my husband had a ten day test run with this device and could not wait to have the electrodes removed because his spasticity increased so much in his trunk area.(T4 incomplete) His urologist could not explain this reaction and I was unable to find anyone at Medtronic who knew if any other persons with SCI had tried this with similar results. Anyone had a similar reaction or success with this? Kathy

[SCI-Nurse]

I am not familiar with a system manufactured by Medtronic. I know they make the baclofen pump, spinal cord stimulator for pain controller, and deep brain stimulator but I did not know that they made one for bladder stimulation. I am familiar with the one manufactured by Neurocontrol called the VOCARE system.

The company's literature states that "The VOCARE bladder system is an implanted medical device which has been used to empty the bladder on demand. A secondary benefit from the system us to aid in bowel evacuation". It is surgically implanted by a neurosurgeon. It has both implanted and external components. The system sends electrical signals through electrodes to the nerves that lead to the bladder or bowel. The person controls the implant with an external controller. The best candidates for this procedure are those with clinically complete SCI's who are neurologically stable and have intact reflex bladder contractions. The surgical procedure to implant this can take 6-12 hours and involves a surgical cutting of spinal nerve roots to prevent futher reflex incontinence and the placement of electrodes to an implantable receiver-stimulator under the skin of the abdomen. There are actually 4 incisions made to accomodate everything. It usually involves a 4-5 stay in the hospital following surgery. Possible complications are listed as device malfunction, lead breakage, spinal nerve root damage, infection, skin breakdown, continued post-operative incontinence, and/or temporary changes in lower limb reflexes. So far, patients who have had this performed report increased quality in their life. Our representative here is telling us that the best candidate is a female who finds it most difficult to self-cath and continues to have reflexive wetting between caths. To find out more about this system you can contact www.neurocontrol.com (http://www.neurocontrol.com). PLG

[Wise Young]

Here is a very critical review of the Interstim device. Judge for yourself. It contains links for many other sites.

http://www.incontinet.com/empire4.htm

[SCI-Nurse]

Wasn't familiar with the Medtronic system before as it is not being used here with our SCI population. You can check their site as well at http://www.medtronic.com/hic/bladder.html

PLG

[Wise Young]

The Interstim device was rally designed for people who need bladder stimulation and not necessary for spinal cord injured people for whom the stimulation would greatly increase spasticity. The Vocare system, in order to avoid the spasticity, requires the cutting of the sacral dorsal roots so that the stimulation does not activate the spinal cord. Cutting of the roots would be very difficult to reverse and therefore the Vocare system has not been as popular. However, there is some research that suggests that the stimulation can be modulated in such a way that it does not activate the spinal cord as much and thereby not require the cutting of the roots.

Wise.

[SCI-Nurse]

Thank you Wise for the clarification. PLG

[KDK513]

(Sigh), how I wish I had this information before we agreed to this test. I approached his Urologist about the Vocare System because I had read the glowing reviews of happy patients. He could not wait to do the surgery. Everything I had read indicated a simple outpatient procedure. We arrived at the University Hospital anticipating this only to be told that the surgeon had changed his mind and wanted my husband to be under general anesthesia with all the possible complications of AD. Medtronic had sent a representative to observe the surgery and "quickly advise" us how to use the device. Through the test period the urologist was unavailable for questions and concerns, though his nurse attempted to help. There was absolutely no follow up from Medtronic or his Urologist although we pursued both with questions and each referred us to the other. What a dissapointment this was. Kathy

[heartstorms@gmail.com]

I am a 52 year old woman with a SCI of 34 years post, I am T12, L1, L3 incomplete. I am wheelchair bound.

I looking for advice from anyone who has experience or knowledge with Interstim therapy on a SCI person.

I am scheduled for surgery and need information as soon as possible.

My main concern, of course is, will it work?

My concerns are:
-sitting and putting pressure on the site of implant, as well as, where the leads are.
- breaking the implant due to falling, as I am quite active.

[smashms]

I used one for about 6 months and no it didn't work as it is not for people with SCI

[MikeC]

They had me test it for about 10 days before doing the implant. The test didn't work so no implant. Are they testing it on you before doing the implant? Mike

[smashms]

mike with me the test did work and worked for about 6 months then for some reason it stopped working all of a sudden, tested it with their programmer and all seemed fine. they finally took it out this past august due to me needing an MRI again. It was doing no good for me anyway so the risk of taking it out was less than leaving it in.

[SCI-Nurse]

Interstim does not give you voluntary control over urination. it MAY (and this is a big maybe) help reduce bladder spasm and leakage between intermittent catheterization. It is not used instead of intermittent cath, so does not make you void or urinate. I would never recommend this for someone who is not going to have a trial external stimulator implanted first, and who tries it that way for at least 2 weeks. It is really not indicated for those with SCI, esp. with complete injuries.

(KLD)

[shellbie0318]

Just to let everyone know, I have the interstim from medtronic. At first it was a bit much and aggrevated the injured part of my spine since I had injured my lower back to the tail bone. However, I had surgery in Dec. 2011 and Im still doing great. I did take me awhile to get used to and I do get shocked occasionally. So, if the trial worked for you I highly recommend sticking with it a little longer to get used to the device. I rarely have accidents and that is a wonderful feeling for this 42 year old.
For anyone, who has this device and has the batteries replace can you please share your experience and just curious of an aprox amount of money spent on the surgery since I do not have insurance to cover my future expenses. Thanks :)

[smashms]

shellbie are you a person with SCI if not then your expierence does not count as the interstim is not recommended for someone with SCI or neurological disease.

[SCI-Nurse]

Smash, actually the Interstim IS FDA approved for use in people with MS, but it is NOT for those with SCI, and rarely is effective.

(KLD)

[smashms]

i was told differently KLD since i have both that is why it didn't work with me

[whozethere]

I am new to the forum. I am not a spinal cord patient, but have recently had the interstim implanted. I do have developmental hip dysplasia and osteoarthritis of the hips, spine and neck. I am also a nurse.

My trial actually has so far worked far better than the implant. I did talk with a Medtronic Ambassador and found out there are tons of programming options although you walk out with 4 and change as needed. They reset these in the doctor's office. I have a feeling it is going to take a while to find something that worked as well as the trial.

I am a bit irked that my urologist did not give me discharge instructions nor the medtronic rep. It is important to know the do's and don'ts when you go home.

I will say, the trial actually helped block a lot of the lower back and hip pain that is part of my daily life. Not so much yet with the implant. (I have had the left hip resurfaced and will be getting a total joint eventually on the right.)