Associates in Urology: IC Surgical Options

Interstitial Cystitis (IC)

SURGICAL TREATMENTS

Sacral Neuromodulation – The experience with implants of sacral nerve stimulation (Interstim TM by Medronics in Minnesota) has been quite favorable. This device was initially approved by the FDA for the treatment of intractable urge incontinence. Later on it was also approved for patients with symptoms of urinary frequency, urgency and pain. In our practice, the experience with the Interstim implant in patients with IC has been quite favorable but we reserve it for patients who failed all the above mentioned traditional treatments. This ambulatory procedure is performed in 2 steps. In the first one, a wire is thread through the skin of the lower back and is directed into the sacral roots (S2 or S3). The wire is then connected to an external stimulator and the patient’s symptoms are monitored for seven to ten days. If at least 50% symptomatic improvement is reported by the patient, a permanent implant is then surgically implanted as a second step, including a permanent stimulator. In our experience we were surprised to find out that not only the symptoms of frequency and urgency improved, but on many occasions the pelvic pain had dramatically diminished, though not necessarily always disappeared. Nevertheless, this is still a surgical procedure and the implanted device may require surgical revisions, at an estimated rate of 20-30%.

In the past surgical treatment for IC included augmentation cystoplasty and urinary diversion with or without cystectomy. These modalities are rarely offered today and it should be reserved to end-stage IC cases and to highly motivated patients. The patient should be informed of the consequences of the surgery and that there is no guarantee that the symptoms will be resolved.

by Yitzhak Berger, M.D.

Updated June 23rd, 2007