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Sacral Nerve Stimulation Therapy

Sacral nerve stimulation therapy (also known as sacral neuromodulation therapy) is one of several treatment options for the symptoms of overactive bladder.

SNS imageIt is a reversible treatment that uses a small device to send electrical impulses to nerves located in the lower back (just above the tailbone). These nerves, called the sacral nerves (specifically S2, S3 and S4), alter muscles and organs (the bladder, sphincter, and pelvic floor muscles) that contribute to bladder control. The electrical stimulation can often successfully eliminate or reduce certain bladder-control problems in some people.

Read about one patient's experience with sacral nerve stimulation therapy.

Which patients typically receive this treatment?

Sacral nerve stimulation therapy can be used to treat overactive bladder with or without urine leakage and also bladder-emptying problems. Sacral nerve stimulation therapy is most appropriate for those patients who have not been helped by more conservative treatments such as drug therapy. Ordinarily, a trial of medications, behavioral and/or physical therapy must be completed before being considered for the sacral nerve stimulation therapy.

The procedure

The sacral nerve stimulation procedure is done in two steps, which allow your physician to test the therapy before actually implanting the permanent battery.

Step 1: The test stimulation

This step is designed to determine if this treatment will improve your symptoms. Before Step 1 you will have to keep a bladder record for at least three days to establish a baseline record of your symptoms for comparison after the test stimulation.

In the first stage, the permanent lead will be implanted. As with any surgical procedure, you will need to have a history and physical examination, routine laboratory tests, and possibly an EKG (cardiograms). You will not be able to eat or drink anything after midnight on the day before the surgery. This procedure is done in the operating room using light sedation. You will lay face down on an examination table and you will receive a local anesthetic into your skin so the area where the surgeon will work is numb. The physician will use a xray machine to locate the place to insert the lead (a thin wire). The procedure involves insertion of a needle and lead near the sacral foramen (appropriate sacral nerve which is in the lower back) on the left or right side.

Stimulation is applied and the patient is asked to identify the location of the sensation: the vagina, rectum or the space between the vagina and rectum (perineal body). Usually the stimulation sensation is a vibration or pulling sensation in the vagina or rectum. Once the person feels the sensation, then the physician will monitor the anus (opening to the rectum) or toes. Tightening of the anus or flexing of the big toe will occur if the appropriate sacral nerve is being stimulated.

Once the response is confirmed, a lead wire is threaded through the needle and the needle is removed, leaving the temporary lead wire in place. The lead is tunneled to either the right or left buttock where a small pocket is made. This pocket will be expanded if the battery is inserted following successful test stimulation. A lead extension will be tunneled to the opposite buttock from the pocket and brought up through the skin. This lead extension will connected to an external stimulation device. This device will be programmed in the recovery room. The external stimulator unit should be left on 24 hours a day. The test period can be for up to three weeks. The programmed settings on the external stimulator may be adjusted during this time based on your response to the stimulation. While you have the test stimulator in place you should limit some of your activities (for example, no lifting, no sexual intercourse, and no baths).

You will need to record your symptoms using the same three-day bladder records you used before the Step 1 procedure. If your symptoms improve by at least 50 percent (decrease in urgency, frequency, or incontinence), long-term use of sacral nerve stimulation therapy may be appropriate for you and you may proceed to Step 2.

Step 2 : The implant of the sacral nerve stimulation neurostimulator

If your symptoms decrease by at least 50 percent and you are pleased with the test results, you are considered a good candidate to have implantation of the permanent battery.

During the second stage procedure, the small pocket made during the first procedure is opened and made larger. Into this pocket the battery is placed and connected to the permanent lead arising from the sacral nerves. The procedure is quick and can be performed under general anesthesia (you will be asleep during the procedure).

Initially, the doctor uses a device called a "programmer" to set stimulation settings and to check neurostimulator information. The patient is given a hand-held programmer with replaceable battery to turn the stimulator on and off and to adjust the battery output amplitude as needed. The healthcare provider will teach the patient how to use the programmer. You and your doctor or nurse will adjust the stimulation settings to maintain the most effective control of your symptoms without discomfort. You may need to make several visits to fine-tune the settings that are best for you. You can adjust the stimulator by using the knobs on the unit to slowly increase or decrease the intensity. The neurostimulator typically runs for 5-10 years. However, depending on the person's usage requirements, it could be less than 5 years. When the battery runs out, the neurostimulator will need to be replaced, typically during an outpatient procedure.

Find out more about sacral nerve stimulation therapy on the Medtronics website.

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