A new device that gives patients more control over neuromodulation treatments for bladder leaks and urgency is now being offered to Johns Hopkins patients in the Greater Washington area. 

Johns Hopkins urogynecologist Shannon VanderPas Lamb, based at Sibley Memorial Hospital, is among the few urogynecologists nationwide who are trained and approved to use the device, which gives patients more control over their therapy compared with other treatments.

The device consists of a capsule about the size of a paper clip, implanted behind the ankle bone in an outpatient procedure under local anesthesia. It sends gentle electrical pulses through the tibial nerve to the bladder, helping calm — or downregulate — the overactive nerve signals responsible for bladder leaks. The battery and controls are worn in a bracelet around the ankle.
“Patients wear the ankle bracelet for treatment twice a day for 30 minutes,” says Lamb. “The advantage over other devices is that it’s patient-controlled, so they do it at their convenience. They don’t have to come to the office for it.”

What’s more, she says, patients “don’t have to worry about the battery running out. It can easily be replaced, rather than having surgery to switch out the battery. And it’s programmable, so programs can be modified based on their response.” Some patients may also be able to taper their duration of therapy over time, she says. 

Neuromodulation isn’t new, says Lamb. Urogynecologists have been using it to treat urinary incontinence for decades. The difference here is the convenience for patients. 

Other types of neuromodulation treatments in urogynecology include sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). With SNS, a device implanted in the buttock sends electrical impulses to the sacral nerves. Surgery is required to change the battery. 

PTNS is a noninvasive treatment similar to acupuncture, requiring clinic visits once a week for 12 weeks, and then once a month for maintenance, says Lamb. 

Those treatments are generally offered to patients after they have tried Botox and other medications to calm their bladder urges. The newer device can be offered earlier in the treatment cycle, says Lamb, allowing patients to avoid medications with potential side effects. 

There are also fewer restrictions for people who have metal in their body already, such as for a knee or hip replacement, she says. 

According to the device-maker, 79% of study participants experienced reduction in bladder leaks by 50% or more; 97% reported satisfaction with the product.  

“It’s another option in our toolkit,” says Lamb. “I think patients will elect to do this more than other things, once we get the word out and they understand how it works.”