Potential barriers to interstem therapy for overactive bladder include lack of patient knowledge and patient misperceptions about the device. Although manufacturer educational materials exist, the majority of these materials were not developed using a patient-centered, needs-based approach. To fill this gap, we developed an innovative video to address the information, knowledge, and decision-making needs of women considering interstem as a treatment option for overactive bladder. The chosen excerpts cover content that is not addressed in already existing materials. These excerpts were chosen to demonstrate the novel aspects of the video. Our video content covers the following domains. Video production was performed by Women and Infants Media Center with three-dimensional computer animation created by BioDigital. To get started, let's look at a few clips from the domain General Knowledge. Interstem is a medical device used to treat overactive bladder. This photograph shows the interstem device with common household items for comparison. The interstem device is actually very light. The interstem device weighs slightly less than four U.S. quarters at approximately three-fourths of an ounce. The external device is roughly the same size as a garage door opener and can be worn on your pants like a pager or a cell phone. We will now look at some footage about expectations. Patients often ask what the interstem device feels like. You can expect to feel a slight vibration or pulse in the vaginal area, buttock crease, or occasionally in one leg after the interstem device is placed. Some patients have described this as a pulling or tingling sensation. This sensation should not be painful. The following segments will cover some aspects of device efficacy. Patients report decreasing the number of pads used per day from six to one. In practical terms, this may mean you only need to carry one extra pad in your purse instead of several. The following clips will provide an overview of a staged implantation. The full-length video also covers peripheral nerve evaluation, or PNE. However, due to time limitations, this was not included in this shortened version. During the stage one procedure, a small wire is placed near the nerves to the bladder. The wire will allow small electrical pulses to affect the nerves to your bladder, decreasing overactive bladder symptoms. This wire is then connected to an external controller that can be used to find the best settings to decrease your overactive bladder symptoms. With the stage one procedure, both an internal and an external wire are placed. The external wire is connected to the external controller. The stage one procedure is done in an operating room. In the operating room, the interstem device will be attached to the previously placed internal wire, and both will be placed under the skin. We will now look at a short segment addressing anatomy. This will be done in an area that previous patients have referred to as the lower back, upper buttock, or posterior hip. These are some of the aspects patients requested about postoperative recovery. After surgery, your lower back and posterior hip will be covered with a bandage and will appear something like this. You will then be taken to the recovery area where you will be taught how to use your external controller. Since this is an outpatient surgery, you will be able to move around like you normally do when you leave the hospital, and you will be given a prescription for pain medications as needed. You may return to work a few days after the stage one procedure, although some doctors limit driving during this time. It is important that you again keep track of your symptoms with a bladder diary, so you can compare this diary with the one prior to surgery. This will allow you to see if the device works for you. The trial period typically lasts one week. This is what your back will look like after one week. After the stage two surgery, your lower back will look something like this. Many patients have asked about scar tissue formation, but as you can see from the pictures, the incision is small and will generally be covered as it is on your lower back or posterior hip. This footage discusses device maintenance. The remote control can be used to increase or decrease your InterStim settings. The strength or intensity of the sensation will depend on how high or low you set your device. Remember, you can change the settings on your InterStim device, including turning it on or off with your remote control. Because the InterStim battery is not rechargeable, all patients who have InterStim placed will eventually need another surgery to replace the battery. The following segments cover some potential side effects. As we have discussed, InterStim works by sending electrical pulses to the bladder. These pulses may affect the bowel as well. Six percent of patients report unwanted bowel changes after InterStim. Most electrical devices and magnets encountered in day-to-day life are unlikely to affect the InterStim device. However, some people will feel increased stimulation from devices such as theft detectors or security screening devices. We will now view footage about some of the reported complications from InterStim therapy. One year after surgery, 15 percent of patients have pain where the InterStim device or wire was placed. In approximately 10 percent of patients, the wire will move. This may cause the InterStim device to stop working. Six percent of patients report the slight sensation of an electric shock to the bicycle seat area. Using more specific terms, this means the buttock, rectum, buttock crease, vaginal area, or sometimes down one leg. Only six percent of patients develop an infection after this procedure. These infections may be mild and only affect the skin, in which case they can be treated with antibiotics. More serious infections may require removal of the InterStim device. One out of every 10 patients will choose to have the InterStim device removed because of pain, loss of function, or infection. As was mentioned previously, the battery will need to be replaced when it runs out of power. This will need to be done in approximately five years. This surgery is reversible and the InterStim device and wire can be removed at any time. The last domain we will look at is postoperative restrictions. You cannot have an MRI if you have an InterStim device in place, even if you turn the InterStim device off. You also cannot have a form of deep heat treatment called diathermy if you have an InterStim device in place.

interstim therapy

overactive bladder

patient knowledge

device misperceptions

patient-centered educational materials