Focus on Urinary Urgency-Frequency and its Treatment Who Suffers From Urgency-Frequency

Urgency-frequency is characterized by the uncontrollable urge to urinate, resulting in very frequent small-volume voids. Sometimes referred to as the urgency-frequency syndrome, interstitial cystitis and urethral syndrome are debilitating conditions most often characterized by urinary frequency urgency, dysuria and related pain without objective urologic findings. Patients complain that they never feel empty after voiding and may present with pain or discomfort with their urinary condition and possibly, incontinent episodes that result from an inability to control the overriding urge to void. It is estimated that approximately I million people in the U.S. struggle with symptoms of urgency-frequency. While urgency-frequency primarily affects females, males can present with identical voiding symptoms. 

Quality of Life Reduced Substantially

Some patients experience the urge to void as often as every half-hour and three to four times a night. If they try to postpone urination, they may leak urine. These symptoms are very disruptive to activities of daily living. Patients cannot drive long distances without stopping, attend meetings, or socialize normally. Their sleep is often impaired by nocturia, so they often feel tired and run down. Though not all urgency-frequency patients experience pain, many find those symptoms even more debilitating than the frequency and urgency. In an effort to manage their condition, patients may resort to dehydration. They may also withdraw from work and social activities, becoming isolated, depressed and even suicidal.

Traditional Treatments Not Effective for All

The typical course of medical treatment includes behavioral programs, pharmacologics and non-surgical interventions. Though these treatments provide relief for some patients, a significant group of challenging patients do not respond or experience uncomfortable side effects. Disappointment and frustration may cause patients to seek help from one physician after another. It is important for patients to understand that there are options available to address their bladder problems.

New Therapy Available for the More Challenging Patients

In April 1999, the Food and Drug Administration (FDA) approved InterStim Therapy, Sacral Nerve Stimulation for Urinary Control for the treatment of significant symptoms of urgency-frequency and urinary retention. This reversible therapy involves electrical stimulation of the sacral nerves that control voiding function. A diagnostic screening test is performed in our clinic to assess the therapy's effectiveness. The patient is given a local anesthetic, a test stimulation lead is placed percutaneously near the appropriate sacral nerve, and an external device provides stimulation for several days. If the patient experiences ³50% improvement in voiding symptoms, the InterStim system can later be implanted under general anesthesia.

Clinical Study Demonstrates Efficacy and Safety

The clinical study results bear out the efficacy of this therapy for carefully selected patients who have failed conservative treatments. At twelve months post-implant, 31% of urgency-frequency patients achieved a normal number (4-7) of voids per day, and an additional 33% experienced at least a 50% reduction in the number of voids per day. 61% reported at least a 50% increase of volume voided per void. 82% increased voided volumes with either the same or a reduced degree of urgency before voiding. However, no treatment is without risks. Complications from the surgery included pain, lead migration, and infection. The surgical revision rate was 33%. None resulted in permanent injury and 9% were unresolved at database closure.