Sacral nerve stimulation (neuromodulation)

What is this?

This procedure involves initially temporarily stimulating the nerves in the sacrum to see if stimulation alters bladder function. If the test is successful, a permanent lead is placed into the sacrum and a stimulating implant is inserted into the buttock area

What alternatives are there?

Bladder re-training, physiotherapy, drug treatment, Botox injections into the bladder, bladder enlargement or replacement using bowel, urinary diversion into a stoma.

What to expect before procedure

You will usually be admitted on the day of your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Currently, the procedure consists of two different admissions. During the first admission, under local anaesthetic, a temporary test electrode is placed into one of the sacral nerves in your lower back. The test electrode is connected to a device which generates electrical impulses for 3-5 days. During this time, you will be at home and will be asked to complete an input/output chart. The electrode will then be removed and the results discussed with you. If the initial test shows that the stimulation does alter bladder function, you will proceed to permanent implantation of an electrode and impulse generator. The second admission will involve a general anaesthetic. During the surgery, a permanent electrode will be implanted into the sacral nerves in your lower back and a permanent generator will be placed in your buttock area.

After the procedure

On the day after your surgery, your implant will be switched on and programmed so that you obtain maximum benefit with regard to your symptoms whilst ensuring maximum comfort for you. When the implant is switched on, you will feel a tapping sensation in the genital or rectal area. The device will then normally be switched off and you will be discharged. We will teach you how to use the programmer and will ask you to turn the implant back on after 5 days, once complete surgical healing has taken place. The average hospital stay is 2 days.

Potential side effects