West Coast Urology  –  Geelong   |   Hamilton    |   Colac   |   Winchelsea

A. PROF RICHARD GRILLS

DR KATHRYN MCLEOD

MR PATRICK PREECE

Urological Surgeons

Sacral Neuromodulation

To download a PDF with information about ‘Sacral Neuromodulation’ please click:

 Sacral neuromodulation (SNM) is indicated for:

    • Non-obstructive urinary retention (the inability to urinate or to empty the bladder completely without a physical blockage),
    • Overactive bladder including urgency, frequency, and urge incontinence
    • Faecal incontinence (the accidental leakage of stool).
    • It has also been shown to be effective even in neurogenic bladder conditions such as Parkinson’s and MS.

  • SNM works to normalize the bladder by stimulating the nerve going to the bladder. This nerve is located in the sacrum, which is near the tailbone. A small stimulator device is placed under the skin and is connected to a lead (or wire) that goes near the nerve. The device sends small electrical impulses to the nerve, which in turn helps to improve urinary symptoms and increase bladder control.

  • Sacral neuromodulation (SNM) is a safe, efficacious, and minimally invasive advanced therapy that was developed in 1982, with FDA approval in 1997. To date, there have been more than 300,000 patients treated with sacral neuromodulation implants worldwide.

  • For bladder problems, the success rate of SNM is around 70%, meaning that patients report a significant improvement (not cure) in their symptoms.

 

TO FIND OUT MORE

  • SNM is performed in two procedures or stages. The first stage is a “trial or evaluation” stage to see if the therapy is successful in you before placing the actual device. The second procedure is the placement of the permanent battery.

  • There are different types of batteries, including rechargeable or non-chargeable. These will be discussed with your surgeon to see which suits you best. Battery life is now typically over 10 years. The battery is changed in theatre as a day stay patient with sedation.

  • In the first stage, a “lead” (tiny wire) is placed through a tiny needle-puncture in the skin to stimulate the sacral nerve. The lead is then connected to an external (outside of your body) temporary stimulator that is taped or strapped to your body with a belt during the duration of the trial. The trial typically lasts one to two weeks. During the trial, you will be asked to record your urinary symptoms in a bladder diary to see if there is improvement. A successful response is considered at least 50% improvement in your urinary symptoms.

  • If the trial is not successful, the lead inside your body will be removed at the second stage procedure. If there is success ( at least 50% improvement in symptoms) , you will have a permanent stimulator (battery) placed under the skin in the lower back at the second stage procedure. After the second stage, nothing will be sticking outside of your body.

  • Complications from SNM are typically very low. Some specific risks include temporary pain at the low back/buttock site, bleeding, as well as infection and movement of the lead or other device problems all of which might require repeat surgery to correct.
  • Battery life on the device is variable and you will likely need to have the battery changed in the future. The device can typically be removed without harm to your body.
  • Most severe complications of sacral neuromodulation are associated with lead migration, implant site pain, or infection.
  • The most common concern is that the patient no longer receives a benefit from the therapy or it falls short of patient’s expectations.

 

Pre-operative tests

  • Urine test to exclude infection

Anaesthetic

  • Usually it is sedation only, unless the anaesthetist prefers you to have a general anaesthetic for a specific reason.
  • same-day surgery without the need for an overnight stay in the hospital


Between stages you will be expected to keep a bladder diary.

Wound care

  • You will have a small ~ 2-inch incision over your buttock, as well as a tiny ~ 1⁄2-inch incision near the tailbone.
  • During the first trial stage, when the temporary external stimulator is secured to your body, it is important to keep the equipment and dressings clean and dry.
  • You CAN NOT have a full shower or bath between stages 1 and 2. Most patients perform sponge baths during this time, or if you have a detachable shower head, you can use it to wash the lower half of your body below the dressings.
  • After the second stage, your incisions will be closed with dissolving stitches and covered with medical-grade superglue, both of which will dissolve on their own over time.
  • if you get any redness, discharge or significant pain/throbbing in the wound, you should contact West Coast Urology as soon as possible.


Recovery

  • Most patients can return to a normal routine within days of surgery with only minor activity restrictions.
  • you may get some mild discomfort which may last several days and can normally be relieved with mild painkillers.


Exercise and activity

  • Rest and very limited activity for 3 days after surgery.
  • After 3 days can resume gentle walking and non-physical work (not strenuous)
  • you must avoid strenuous activities, sports and any stretching of the lower back for 6-12 weeks (such as yoga or bowls) as these can cause the wire to move out of position so that the SNM stops working
  • no tub baths or swimming for six weeks.


Driving

  • Safe to resume driving after 2 days


Medications

  • Regular Panadol or Nurofen is often required
  • Sometimes stronger pain relief for 1-2 days such as endone or tapentedol (Palexia) maybe needed.
  • Your surgeon may also place you on antibiotics after each procedure.


Follow-up appointment

  • You will be reviewed in the rooms around 1 week after your Stage 1 procedure, and 2 weeks after your Stage 2 procedure.
  • If you did not receive an appointment when leaving hospital, please contact our staff at West Coast Urology to make one.
  • After the procedure, you will be given a hand-held remote control called a programmer which is used to communicate with your device. This programmer can be used to turn the device off and on. It also can be used to increase the stimulation intensity. You will not need to touch the programmer often, only when wanting to change settings.
  • Programs are settings on the implanted device that help achieve effective bladder control. You will be shown how to use your programmer, though you may not need to use it much if you have effective symptom control. The programmer can be used to select a different program to fine-tune results.
  • You will be issued an identification card indicating that you have an implanted device which should allow you to bypass metal detectors in airports and other venues. If you need to pass through the metal detector, we recommend turning the device off before passing.
  • If you get pregnant when you have an SNM device, we recommend that the device is switched off.
  • You are having upcoming surgery, you should let your surgeon know that you have a SNM, so that you can turn it off prior to surgery, so that any shortwave diathermy, microwave diathermy or therapeutic ultrasound does not affect your device.