Millions suffer from urological problems.  They try traditional treatments like sacral nerve stimulation to treat their pelvic or urinary pain, fecal or urinary incontinence—but still the problem persists.  However, now a Michigan doctor has pioneered a treatment that could be the solution these patients are searching for.

“For months, my daughter and I went from doctor to doctor to doctor,” Donna Pelto, told Ivanhoe.

"Right away we knew something was wrong, we just didn’t know what,” Becky Petrie, Donna’s daughter, told Ivanhoe.

However, Donna knew how to describe her debilitating pain.

“You get your charcoal briquettes to the point where they're red and they're hot, and then stick them up in between your legs. That's what it feels like,” Donna explained.

Beaumont urologist Kenneth Peters pioneered an outpatient procedure that would relieve her pain.

“We’ve developed a way to place the electrode at the pudendal, which is a nerve that comes further deeper into the pelvis,” Kenneth M. Peters, MD, Chairman of Urology, Director of Beaumont Women’s Urology Center, Beaumont Health System, told Ivanhoe.

An electrical pulse generator is connected to the electrode and implanted in the patient’s buttock.

"It is a pacemaker for the nerves that control a lot of functions of the pelvis such as the bladder, the bowel, and the pelvic floor,” Dr. Peters said.

The device sends a signal to the brain to ignore abnormal signals that cause bowel and urinary issues, or pelvic pain like Donna’s. The level of relief is remotely controlled by the patient.

Since receiving the treatment, Donna says she feels a major difference.

“Every patient I see for the first time, I tell them they're going to be better because I believe it 100 percent,” Dr. Peters said.

This procedure is not to be seen as a cure, but it is successful nearly 85 percent of the time in providing at least a 50 percent relief in symptoms. 

 

BACKGROUND: Pelvic pain is easy to identify because it is the lowestpart of the pelvis and abdomen. This type of pain may be considered very intense and the pain is known to travel to the thighs, lower back, or buttocks. This pain is common in women and men and can come about from musculoskeletal sources, or from urinary or reproductive systems. (Source: http://www.mayoclinic.com/health/pelvic-pain/MY00124)

CAUSES: Women are more likely to experience pelvic pain more than men, but it is not unheard of for men to experience the same pain. In women, pelvic pain can stem from an issue in the reproductive organs. The pain may also arise from internal organs such as the colon or bladder. Common causes in men and women are:

SYMPTOMS: When symptoms occur, a person may find relief in lying down or resting. Pelvic pain may become extreme if one is standing for a long period of time or during exercise. Typical signs and symptoms are a constant severe pain, pressure in pelvis area, intermittent pain, and cramping or sharp pain. If any symptoms are to last more than six months, then pain can be described as chronic.  (Source: http://www.mayoclinic.com/health/chronic-pelvic-pain/DS00571/DSECTION=symptoms and http://women.webmd.com/causes-symptoms-chronic-pelvic-pain)

NEW TREATMENT: A pacemaker for the pelvic region of the body is now being used to control patient’s pain. The pudendal nerve stimulation is a new treatment that stimulates the pudendal nerve to improve the function of internal organs. This method is preferred over the sacral nerve stimulation because there are no side effects to other parts of the body. The procedure is done as an outpatient as doctors place a small electrode in the pudendal nerve near the pelvis. Once the procedure is over, patients are able to control the stimulation of the nerve by a click of a button. (Source: http://www.neuromodulation.com/pudendal-nerve and http://womenshealth.beaumont.edu/pudendal-neuromodulation)

Kenneth M. Peters, MD, Chairman of Urology, Director of Beaumont Women’s Urology Center, Beaumont Health System, talks about a new treatment for patients with pelvic pain.

How do you measure the success of this procedure and how long can a patient expect the results to last? 

Dr. Peters:  The nice thing about neuromodulation is that we can do it in two stages.  So, you get to sort of test drive the car before you buy it.  In the first stage of the procedure, we put the patient under light sedation so we can place a little electrode down by the pudendal nerve. Then, we externalize that for two weeks.  So, they go home with a wire coming out of them, connected to a temporary pacemaker that sort of looks like a transistor radio.  It has a 9 volt battery and a volume dial on it.  However, the electronics in it allows us to program it differently so we can stimulate the nerve the way we think will work best for the patient.  Prior to having that test done, we have them fill out pain scores. For the two weeks, we let them see how their symptoms change over time.  We consider at least a 50% improvement in symptoms a success.  If they have a 50% improvement in symptoms, then we’ll go ahead and implant the permanent pacemaker. It looks just like a heart pacemaker and this could be implanted in the body.  Now, there are no more wires coming out and then this will allow chronic stimulation for the patient. 

I understand people are coming from all over for this procedure. Can you talk about that?

Dr. Peters: We opened the Women’s Urology Center at Beaumont to service a need of patients with chronic pelvic pain.  The reason is that most women who suffer from this have gone from doctor to doctor seeking help. What became clear to us is that we really needed a multidisciplinary approach to not only evaluating, but treating this and that’s what the Women’s Urology Center at Beaumont is.  So, we have clinicians here who have been specifically trained in chronic pelvic pain like nurse practitioners and pelvic floor physical therapists. We have integrative medicine with acupuncture and guided imagery and massage therapy and then we have psychological services because these patients deal with a lot in their lives because of the chronic pain.  It affects their relationships, their life, and the time they can spend with their family.  So, because of that, we have become known across the country.  We have had patients in this past year from 26 different states and 4 different countries; we’ve had patients travel to Beaumont for neuromodulation from as far as Australia. 

Wow, that’s amazing.  Are you teaching other doctors to perform the procedure and if so, where are they located?