interstim: physician interviews

by Diane K. Newman, RNC, MSN, CRNP, FAAN

The following physicians who perform the InterStim® procedure were kind enough to answer a few questions on this treatment.

Dr. Eric Rovner is a urologist and an assistant professor of urology at the Division of Urology, University of Pennsylvania Health System in Philadelphia, Pennsylvania. He specializes in the diagnosis, evaluation and treatment of urinary incontinence and pelvic disorders in both men and women. Dr. Rovner completed his residency at the University of Pennsylvania. He completed his fellowship at the University of California-Los Angeles specializing in urinary incontinence and pelvic disorders in women. He is board certified in urology and a member of the American Urological Association. He has lectured internationally on a wide variety of urologic topics and authored several articles and chapters in medical journals and textbooks on urinary incontinence and overactive bladder (OAB). He is presently doing research in the area of OAB and related pelvic floor muscle disorders.

Dr. Chip Butrick is a practicing Urogynecologist in Kansas City, specializing in the management of fecal and urinary incontinence, pelvic reconstruction and pelvic pain. His area of special interest involves neurourology and how bladder and pain dysfunctions are often times neuropathic abnormalities. His ideas in this area have been crystallized through working with such mentors as Dr. Tom Benson and Dr. Rick Schmidt. He has authored several chapters in a textbook on pelvic pain, and is presently doing research in the area of hypertonic pelvic floor muscle dysfunctions. A major part of his career is involved in presentations and educational programs done around the country and proctoring physicians in new surgical techniques. He has been on faculty and/or moderating the annual meeting of the American College of OB/GYN's Postgraduate Program involving pelvic pain and urologic pain disorders for the past five years.

Who is the most appropriate person to receive the InterStim® Therapy?

Dr. Rovner - The most appropriate person for InterStim® Therapy is one who has bothersome symptoms of overactive bladder (OAB) and who has not responded satisfactorily to behavioral therapies, pelvic muscle exercises, and pharmacological measures. He/she must be willing to undergo a two-step process including surgical placement of the device, which requires anesthesia. Therefore, the patient must be sufficiently healthy to undergo general anesthesia.

Dr. Butrick - InterStim® Therapy has been approved as a form of sacral neuromodulation for the treatment of urge incontinence, nonobstructive urinary retention and chronic urgency/frequency syndrome. Each of these problems can often be managed with more traditional therapies such as behavioral modification, pharmacologic interventions and at times intravesical therapy as well. However, these traditional approaches may not be successful and thus InterStim® Therapy is ideally suited for people with the above-mentioned problems who have failed traditional therapy. One of the most enigmatic problems that face urologists or urogynecologists is the management of patients with chronic urgency/frequency syndromes.

Dr. Rovner - The overall response rate for the first step is about 50-60 percent, however, in my experience, this success rate has been improving dramatically over the past few years with improved patient selection, implantation techniques and equipment. In my experience, if a good response occurs from the test stimulation, then the success rate is very high, approaching 90 percent.

Dr. Butrick - It is important to note that InterStim® Therapy is a technique that modulates the problem at times all the way to complete success but probably more commonly it "modulates" the problem to a point of marked improvement with a significant improvement in quality of life. In speaking with the handful of physicians who are trained in the technique of InterStim® Therapy, I find we each have patients that have demonstrated total resolution of their symptoms of urge incontinence, urinary retention and urgency/frequency syndrome. However, we have many more patients who report a marked improvement in symptoms but still require the use of medications and simple behavioral techniques to maintain complete satisfaction.

Dr. Rovner - The most common complications in my practice include pain at the implantation site, and infection, but these are uncommon.

Dr. Butrick - At this point, the most common complication of the procedure in my experience is infection at the time of lead placement or at the time of placement of the neurostimulator. Infections of a minor degree occur in less than 10 percent of implants and if they do not respond to aggressive antibiotic therapy, they can result in the need for explantation (removal) of the lead and neurostimulator

July 2002
Last update July 2009

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