Surgery for Overactive Bladder: When Do You Need It?

What to consider when lifestyle changes and medication don’t work.

Treating overactive bladder with surgery is an option when lifestyle changes and medication don’t work. In this episode of Health Insights, Dr. Holly Atkinson sits down with Dr. Harris Foster to discuss overactive bladder and why surgery may be the best choice for you.

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This video features Holly Atkinson, MD. Dr. Atkinson specializes in internal medicine and is an award-winning medical journalist.

Duration: 3:38. Last Updated On: Jan. 9, 2019, 3:57 p.m.

Reviewed by: Suzanne Friedman, MD, Dr Helen Maliagros Scott, Preeti Parikh, MD . Review date: Jan. 9, 2019

00:00 [MUSIC]
00:06 Welcome to HealthiNation. I'm Dr. Holly Atkinson.
00:10 Treating overactive bladder with surgery is an option when lifestyle and
00:14 drug therapies haven't worked.
00:16 I spoke with Dr. Harris Foster, Professor of Surgery in
00:19 the Division of Urology at the Yale University School of Medicine.
00:23 About the surgical options to treat overactive bladder.
00:26 There's nerve stimulation.
00:29 Either through the skin or actually surgery, surgically implant it.
00:36 Essentially, the way I describe it is a bladder pacemaker.
00:39 The first step is to,
00:42 place an electrode next to one of the nerves that go to the bladder.
00:48 And you stimulate the nerve and you assess whether or
00:52 not stimulation of the nerve improves the overactive bladder symptoms.
00:58 And then the second phase is to go back to the operating room and connect that
01:01 electrode to a pacemaking device, which is about the size of a wafer.
01:06 And you place that underneath the skin.
01:09 >> Now who's a good candidate for this procedure?
01:12 >> Well I think anybody with OAB who's healthy enough
01:18 to have a minor surgical procedure.
01:21 >> Now are these for people who have tried medications and
01:24 for the most part the medications have not worked or people who prefer not to
01:28 take medications and would rather go for something like this?
01:31 >> Well, in my experience it's almost exclusively for
01:35 patients who have tried medications because when given the option,
01:39 most patients are gonna choose medication over surgery.
01:42 >> What are the complications from sacral nerve stimulation?
01:47 >> Well there's the general risk of any surgery.
01:52 And that is bleeding, infection, reaction to anesthesia.
01:58 There is risk, because it is a foreign body.
02:00 Whenever you put a foreign body into a human,
02:04 there's a risk of infection right after operation, after the operation.
02:08 And there's a risk down the line.
02:10 >> Any percentage for this operation?
02:13 >> I'd, I'd say it's low, less, less than 5%.
02:17 But it is there.
02:20 >> Other surgical options?
02:21 >> More aggressive surgery to in fact enlarge the bladder.
02:26 We use it more, more often in patients who have
02:30 over-active bladder due to neurologic diseases such as spinal cord injury.
02:37 Multiple Sclerosis where they it, it's totally uncontrollable.
02:41 Essentially what it is you're going into the operating room,
02:44 you open up the abdomen, you split the bladder in half, you take a piece of
02:49 intestine turn it into a patch, and put it on top of the bladder to make it bigger.
02:54 This is called Augmentation Cystoplasty.
02:58 It's a major operation.
02:59 It's, multiple days in the hospital.
03:03 Most patients who, have that operation, are unable
03:09 to empty their bladder because it, it interrupts the bladder's ability to empty,
03:13 and they have to do what we call self, catheterization.
03:17 >> So here's the insight.
03:19 Bladder enlargement is a procedure for a small minority of patients.
03:23 Sacral nerve stimulation is worth considering if lifestyle and
03:27 drug therapy haven't worked.
03:29 As with any surgery, this procedure has risks.
03:32 So be sure to discuss them with your doctor.
03:34 [MUSIC]