Sacral neuromodulation

What is Sacral Neuromodulation?

Sacral neuromodulation may effectively treat overactive bladder. It may alleviate leaking and the frequent, strong, and sudden urge to go to the toilet. It may also alleviate symptoms of retention that are not caused by an obstruction. In some cases, it may alleviate symptoms of interstitial cystitis. Sacral neuromodulation may also treat faecal incontinence and chronic constipation in some patients.

Sacral neuromodulation is a therapy that's used when more conservative options (such as dietary changes or biofeedback) haven't worked or are too difficult to live with. A doctor will assess each patient's suitability for the treatment.

What does Sacral Neuromodulation involve?

A small device, similar to a pacemaker, is surgically implanted just beneath the skin in the upper buttock. It is called a neurostimulator. It's about the same size as the face of a typical stopwatch (44 mm high, 51 mm long and 7.7 mm thick). A thin wire is implanted in the lower back and connected to the device.

This device acts as a battery and stimulates the appropriate nerves via the implanted wire by using mild electrical impulses. By doing this, it can help restore coordination between brain, pelvic floor, bladder or bowel and sphincter muscles.

Evaluation Phase

A thin temporary wire is inserted near the nerves in your lower back, the so called sacral nerves that control the bladder. The wire is then connected to an external battery which delivers mild electrical pulses to the nerves. This external battery is worn on a belt for the duration of the evaluation. The surgical procedure normally takes less than an hour and is generally done as a day case. After the temporary wire is inserted you'll go home and go about your daily life, continuing to record your toilet habits during this test in a new diary.

After several days of the home evaluation, your doctor will explain the results to you. Several measures will be used to assess whether or not you will benefit from sacral neuromodulation.  These include recording the number of incontinence episodes before and after the test, quality of life assessments, and patient satisfaction.

Implant Phase

Following a positive evaluation, a permanent battery will be surgically placed. Should your evaluation be a failure, the temporary wire will be removed in clinic and your specialist will either consider repeating the test or discuss other options with you.

How do you know it will work for you?

Sacral neuromodulation is performed in two stages, the first is an evaluation/test phase and the next is the implant phase. The evaluation phase allows your doctor to assess whether or not you will benefit from sacral neuromodulation. Before any of this though, you'll spend a few weeks at home recording your toilet habits in a diary form to use as a base for future comparison.

Authorised source: Medtronic limited

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