NEW YORK (Reuters Health) - Implantable stimulators that provide continuous electrical stimulation to the nerves in and around the bladder can benefit carefully selected patients with difficult-to-control bladder control problems, the results of a literature review suggest.
Careful follow-up, however, is critical because a high percentage of patients will develop complications and may even require a second operation, according to the report in the The Cochrane Library, a publication of the Cochrane Collaboration, which evaluates medical research.
Dr. G. Peter Herbison, from the University of Otago, Dunedin, New Zealand, and Dr. Edwin P. Arnold, from Christchurch Hospital, New Zealand, identified eight studies that included 500 patients who did not respond to non-surgical treatments for urinary control problems.
The researchers elected not to pool the data as the studies were judged to be of either poor quality or difficult to assess.
Nonetheless, the report indicates that the patients with overactive bladder symptoms and those with urinary retention problems, but no known obstruction, experienced the greatest benefit from nerve stimulation therapy.
The reviewers note, however, that up to 30 percent of subjects evaluated for this treatment are not suitable candidates. Of those patients who receive an implant, roughly 30 percent experience no benefit or only temporary relief.
“Many of the implants did not work and many required revision operations. Many questions remain about patient selection and the best way to use these devices,” Herbison and Arnold wrote.
Furthermore, there is clearly a potential for complications, the investigators say, “but it appears that most of these can be treated or overcome.”
They also point out that the nerve stimulation therapy for bladder control problems is still evolving. “More research,” they conclude, “is needed on the best way to improve patient selection, carry out the implant, and to find why so many fail. The effectiveness of implants should be tested against other interventions, particularly in people with overactive bladder.”
SOURCE: The Cochrane Library, April 14, 2009.