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Sacral Nerve Stimulation
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Sacral Nerve Stimulation
What is sacral nerve stimulation?
Nerve stimulation is a reversible treatment for patients with bladder control problems in whom
conservative treatments have not worked or have not been tolerated. Conservative treatments include
behavioral therapies (diet modifications, biofeedback, bladder retraining, pelvic muscle exercises) and
medications.
Sacral nerve stimulation involves electrical stimulation of the nerves that control the bladder. Nerve
stimulation can address symptoms of overactive bladder including:
1) urinary urgency: inability to postpone the need to urinate
2) frequency of urination: the need to urinate at least eight times per day
3) urge incontinence: leakage of urine when one gets the urge to urinate
Sacral nerve stimulation also addresses the problem of nonobstructive urinary retention, a urinary
condition defined by the need for a catheter to evacuate urine; spending considerable time in the
bathroom, yet producing only a weak, dribbling stream of urine; urinary leakage; and not having a
sensation that your bladder is full.
Sacral nerve stimulation will not cure these bladder control problems but it can reduce the number of
voids and/or the number of wetting episodes.
How does sacral nerve stimulation actually work?
Sacral nerve stimulation therapy uses a small device (a neurotransmitter) that is implanted under the
skin in the upper buttock area. The device sends mild electrical impulses through a lead that is
positioned close to a nerve located in the lower back (the sacral nerve root), which influences the
bladder, the urinary sphincter and the pelvic floor muscles.
What are the benefits and risks of sacral nerve stimulation therapy?
The benefits of nerve stimulation therapy are that it can greatly reduce or eliminate bladder control
problems, specifically urinary urge incontinence and urgency-frequency symptoms, in people who have
symptoms of overactive bladder. It is also a type of treatment that can be completely reversed and
discontinued at any time without permanent damage to the nerves.
Most risks or side effects are related to the device or the implantation procedure itself and are low
and/or uncommon. The main risks include infection (about 3-4%), or mechanical failure, in which case,
the device would need to be reprogrammed or revised. Other problems such as pain at the implant
site, lead movement, technical problems, and undesirable stimulations/sensations are not common
and can be resolved.
What can I expect in the typical pre- and post- surgical period?
Before the device is implanted, a test stimulation lead is implanted, either in the office or in the
operating room, depending on application. The operative procedure (also known as stage I) is done as
an outpatient and usually lasts about 30-45 minutes. The office procedure has a slightly shorter
duration. A 1-2 week trial of the device using an external generator about the size of a pager follows.
This is performed to demonstrate the effects of sacral nerve stimulation on bladder control symptoms
during everyday activities. If you have 50% or greater objective (according to your voiding diary –see
additional section on voiding diary instructions) and subjective improvement based on questionnaires,
you can then proceed to implantation of a long-term device – stage II, a 15 minute procedure performed
under local anesthesia as an outpatient.
Failure to achieve the desired effect following an office stimulation period does not disqualify you from a
future operative testing procedure or stage I trial.
The incision may feel sore for a couple of weeks. This will lessen as you heal. You may return to your
doctor’s office a few more times over a 6-month period to fine-tune your stimulation settings. Once
adjusted to achieve the best control of your symptoms with the least discomfort, you may need to return
to your physician’s office for check-ups only once or twice a year.
For the first 3-6 weeks after surgery, you will be advised to limit your activities to allow your incisions to
fully heal. Once you are fully healed, you can resume your full and active lifestyle.
Will the device ever need to be replaced?
Yes. The battery inside the neurostimulator typically needs to be replaced every 3-5 years. The battery
life will fluctuate per individual, depending on strength of the signal needed to control symptoms and
amount of use each day. When it is time for the battery to be replaced, the entire neurostimulator will be
replaced.
Are there any medical restrictions related to the device that I need to be made aware of?
Yes. You cannot have an MRI while the device is implanted – even if the device’s battery is turned off.
According to the device’s manufacturer, x-ray and radiation therapy may affect the function of the device.
Diathermy (a type of energy treatment—using radio wave, ultrasound, or microwave) should not be done
on any patient with a sacral nerve stimulator implant. Consult with your doctor before scheduling any
additional therapies or tests. He or she will discuss the need to take any precautions.
Will insurance cover the cost of nerve stimulation therapy?
Many insurance companies will pay for the nerve stimulation therapy. One nerve stimulation device –
the Interstim® Therapy device – has gone through clinical trials and has been found to be safe and
effective and has been approved for use by the FDA.
