Sacral neuromodulation is a procedure that involves the placement of a small device into the body to deliver electrical stimulation to the nerves that run through the tailbone to the bladder with the goal of alleviating or eliminating bladder overactivity and urinary leakage.
The procedure can also help patients with urinary retention who struggle to urinate effectively, acting as a bladder pacemaker. The electrical stimulation typically doesn’t cause any pain or discomfort.
Who Needs Sacral Neuromodulation?
Patients may have overactive bladders (OAB); especially with aging, which requires frequent and urgent urination and in some patients urgency leakage. Other patients may develop a bladder that may stop working completely causing urine retention. These symptoms may also be caused by recent unrelated surgery.
Other conditions that may be treated with sacral neuromodulation include:
- Spinal Cord Injury: In patients with more than 50 percent motor function and who are still able to walk.
- Multiple Sclerosis: Patients who are able to walk well may benefit from sacral neuromodulation.
Benefits of Surgery
Sacral neuromodulation may help reduce symptoms of overactive bladder. The procedure is reversible and may be discontinued anytime.
Patients can experience a hint of what the procedure will feel like during the evaluation to help them understand how it feels and consider if it may be an effective treatment.
Potential Risks
As with any procedure, sacral neuromodulation has its risks and side effects:
- Swelling
- Bruising
- Bleeding
- Infection
- Pain at the implant site
- Issues with the device
- Changes in urinary or bowel function
- Discomfort during the stimulation
What Happens During Surgery
Sacral neuromodulation is performed on an outpatient basis and involves two operations spaced one to two weeks apart.
- The 1st Operation
Patients will be put under twilight anesthesia and lie on their stomach in the operating room. Electrodes will be placed onto the nerves located on both sides of the bladder, and internally connected to temporary wires that will come out of the patient’s side.
Upon awakening, the patient will have their nerves stimulated for one to two weeks from an external unit. If the patient experiences 50 percent improvement in their urinary difficulties or complete resolution of symptoms, then the permanent unit is implanted.
- The 2nd Operation
During the second procedure, a stimulator is implanted above the buttock and hip bone and attached to the permanent electrodes. The unit is expected to last three to seven years depending on how much stimulation is required. If the battery wears out, the unit can be replaced in a small operation without disrupting the permanent electrode located in the nerve.
If results of the first surgery were not satisfactory, then the electrodes will be removed in the second operation.