In a Heartbeat: Treatments for urinary incontinence
The University of Pittsburgh and Magee-Womens Research Institute participated in a pelvic floor disorders study sponsored by the National Institutes of Health to help treat women with urinary incontinence. Researchers that compared sacral neuromodulation — an implantation of a small device that stimulates the sacral nerves with mild electrical pulses — to bladder injections of Botox to help treat women with urinary incontinence. Dr. Halina Zyczynski , medical director of Magee-Womens Hospital of UPMC's Center for Continence and Pelvic Floor Disorders, talked to us about the study and its important findings.
What is bladder incontinence?
Urinary incontinence is the involuntary leakage of urine. There are different reasons for loss of bladder control. One of the most bothersome reasons is unexpected bladder muscle spasms, which usually cause a sense of bladder pressure and urgency to urinate. We refer to this as urgency urinary incontinence.
You were recently the principal investigator for Magee-Womens Hospital of UPMC for a multisite trial that compared therapies of Botox and sacral neuromodulation. How do these treatments help with bladder incontinence?
One of the major causes for urgency urinary incontinence is a malfunctioning of the nerve signals between the central nervous system, the brain and the bladder muscle. The brain, through the spinal cord, is constantly delivering a message for the bladder muscles to relax, stretch and accommodate or hold the urine made by the kidneys. When there is a “hiccup” or “static” in the message to keep the bladder muscle relaxed, it can contract or cramp. Unfortunately, first- and second-line therapies such as reducing the amount of liquid drunk each day or the commonly prescribed oral medications for urgency incontinence are insufficient or poorly tolerated by some patients. It's they who are offered third-line therapies of Botox injection or implantation of a neuromodulation unit. An injection of Botox into the bladder muscle works by relaxing the twitchy or overactive bladder muscles. The electrical stimulator suppresses the spasms by sending electrical pulses to nerves in the spine that control the bladder muscle.
How was the research conducted?
The study involved 381 women from nine U.S. medical centers, including Magee. These women reported having at least six urgency incontinence episodes per day and also reported that they had not improved with other treatments, such as oral medication. The participants were randomly assigned to either receive sacral neuromodulation or a Botox injection. After a trial period to test their responsiveness to the therapies, 364 women were enrolled and followed for six months after treatment. The study team analyzed the number of urgency incontinent episodes in monthly “bladder diaries” along with other measures of symptom bother and satisfaction with the treatment. Participants who received Botox saw their number of daily urgency incontinent episodes decrease by 3.9 leaking episodes on average versus 3.3 in the sacral neuromodulation group. The difference was statistically significant. Botox participants also reported a greater reduction in bothersome symptoms and higher satisfaction with treatment. However, we also found that when compared to the neuromodulation group, participants in the Botox group reported a higher number of urinary tract infections.