Some resistant cases of IC defy treatment options – sacral neuromodulation appears successful.
Int Urogynecol J Pelvic Floor Dysfunct. 2010 Sep 17. [Epub ahead of print]
Minimum 6-year outcomes for interstitial cystitis treated with sacral neuromodulation.
Marinkovic SP, Gillen LM, Marinkovic CM. abstract here
- 34 cases – mean age 41
- “sacral neuromodulation (InterStim, Medtronic Inc., Minneapolis, MN, USA, IPG model #3023 and tined lead with larger lead #1 model #3093) stage one and two* under a general anesthetic”
- Cases need to show a 50% improvement during testing of both voiding frequency and pain.
- “five cases of lead migration (secondary to falls and automobile trauma) and three implantable pulse generator erosions (secondary to trauma) without infection for a re-operation rate of 27% (eight out of 30).”
- They explained complications on fact these were relatively young women – one was a marital arts accident, one a fall off a ladder, one a slammed car door during a tornado alert – those sound pretty active cases alright
results – urgency/frequency scores were
frequency / urgency – 21.61 before – 9.22 after (p < 0.01) – less than 1/2 the frequency
pain – 6.6/10 prior; 2.4/10 after – (p < 0.01). – reduced pain by 2/3
Comment – Around here, bladder installations seem fraught with infections. I feel Sacral stimulation should be considered earlier.
They do mention some other options for the unresponsive:
– Neodynium:YAG laser therapy for the coagulation of Hunner’s ulcers
– trigone-preserving partial cystectomy with enterocystoplasty: – a
Kochakarn W, Lertsithichai P, Pummangura W
Bladder substitution by ileal neobladder for recalcitrant interstitial cystitis.
Int Braz J Urol 33(4):486–492, 2007 free article here
they used part of the bowel to make an new bladder.