Ingenious Cures for Bladder Dysfunction

Rita Dutta - Mumbai

Bladder Dysfunction is a condition affecting numerous Indians. It causes severe disruption to daily routine. However, there is hope with some revolutionary methods being tried out.

For more than two years, Rajashree Deepak Goradia (37) could not step out of her house. Suffering from urinary incontinence, she had to relieve herself more than 30 times in the day and at least eight times at night. “Even if she tried to step out of the house, as soon as she reached the building gate, she had to immediately rush back to the urinal. It was that traumatic for two years,” husband Deepak Goradia, shudders. Rajashree consulted various urologists in the city and was given various medications, but nothing reduced her agony. What ultimately came to her rescue was an innovative technique at Jaslok Hospital, using Botox to cure incontinence.

Ingenious Use

Dr Shailesh Raina

Urinary incontinence, which is caused by spasms of bladder muscle, is either continuous leakage or stress urinary incontinence where patients leak urine on coughing and straining or urge incontinence where patients cannot control the desire and rush to pass urine. It is more common in females. One has, of course, heard of Botox for smoothening wrinkles, but using it to cure incontinence is surely an ingenious method.

Dr Shailesh Raina, Consultant Urologist at Jaslok explains, “When medications fail, Botox helps by preventing hyper contractions of the muscle.” How? A two ml shot of Botox is injected into the urinary bladder by endoscopy. The procedure takes only about 15 minutes and the patient can walk back home on the same day. Depending on the urodynamics of the patient, including the bladder pressure capacity, pressure and compression, the patient may have to take two to three shots after three to six months.

Careful Use

How did Botox, considered the most lethal toxin once, evolve into a therapeutic medicine? “It is lethal in large quantities, but a small dose of two ml is therapeutic,” explains Raina. So far, two patients have been administered with Botox at Jaslok and the treatment has been successful for both, says Raina. “My wife can lead a normal life now, thanks to Dr Raina,” says Goradia. The cost of treatment is about Rs 40,000 to Rs 55,000 for each sitting, which includes the cost of Botox at Rs 20,000.

Cautious Hope

Urologists have hailed this new treatment method. Dr Umesh Oza, Urologist, Bombay Hospital says, “Botox is definitely a new addition to our armament of options to cure urinary incontinence.” The other treatment options to cure incontinence are medication, sling surgery, sacral neuro modulation, use of bulking agents and artificial sphincter implantations.

Oza cautions that one has to choose the patients carefully. “We need more case studies to judge how effective the treatment is in the long term,” he contends. According to Dr S Thatte, Associate Professor, Department of Urology, Bombay Hospital, who has himself injected Botox in one patient, “Proper clinical judgment is required as the success of such techniques is only 50 percent.”

Using Muscle

More than Botox, what has focused the limelight on Jaslok’s urology department is its pioneering bladder atonia surgery, known as Latissimus Dorsi Detrusor Myoplasty (LDDM). The surgery is required for patients with neuropathic bladder, a term used for bladder dysfunction caused by damage to the nerve of spinal cord. Spinal cord injuries present with a bladder which is atonic—has lost muscle tone—and hence cannot empty. The life of the patient is badly crippled, as he requires catheterisation to pass urine.

When Clean Self Intermittent Catheterisation, drugs and Sacro Neuro Modulation (where nerve supply of the bladder is stimulated with an electrode) fail, LDDM works. In this surgery, latissimus dorsal muscle or LDM (shoulder muscle) is detached with its artery, vein and nerve intact. Then this neuro vascular flap is wrapped around the bladder. In course of time, the LDM muscle contracts and helps to empty the bladder when it is full.

Chandigarh-based Jaspreet Kaur, who had bladder paralysis after a spinal cord injury during an accident, vouches for this path-breaking surgery that she underwent six months ago at Jaslok Hospital. Earlier forced to carry a catheter with her wherever she went, she now smiles, “The surgery has changed my life.” Raina was assisted in this surgery by his colleagues, urologist Dr P S Soonawala and micro-vascular surgeon Dr Vijay Hari Bhakti.

Foreign Hand

Dr Arnulf Stenzl

If Raina is basking in the glory of introducing this surgery in India, his teacher Dr Arnulf Stenzl, Professor and Chairman, Department of Urology, Tubingen University, Germany, pioneered this technique in the world. In the 90’s, Stenzl conducted a trial with dogs in Austria, by removing their normal bladders and replacing them with simulated bladders of LDM. After the animal trial proved that LDM is effective in creating pressure to void the bladder, Stenzl conducted the first surgery in humans in 1995. Stenzl, who came down to Mumbai as faculty in the instructional workshop of the Society International Urology Conference, informs, “The technique is practiced with success in Austria and Germany. It improves the quality of life.” Any patient with bladder paralysis below 65 years qualifies for this surgery, he adds.

Stenzl had operated on Mumbai-based boy Amit Solanki (24) in Germany. While a patient takes around three to six months time to recover, Amit took a little longer as he developed an infection.

The only drawback of the surgery is that the patient may not be able to do mountain climbing, as the LDM muscle is used in mountain climbing. “But I can do push-ups without any problem,” says a cheerful Amit.

Expert Response

Indian urologists are keen that such new techniques should be tried out in India. Says Dr Hemant Patkar, Urologist, Lilavati Hospital, “It is a good treatment option.” He is a little daunted by the complexity of the surgery, which takes around six hours and requires an integrated approach by a team of a plastic surgeon, a urologist and a micro-vascular surgeon.

With such innovative techniques debuting in India, hundreds of Indians like Amit and Rajashree could be spared the hassles of sailing to foreign shores for treatment to lead a normal life.

rita@expresshealthcaremgmt.com