Sacral Neuromodulation Melbourne

Sacral neuromodulation is a procedure used to treat men and women are troubled with symptoms of an overactive bladder (urge, urge incontinence, frequency, urinary leakage or chronic urinary retention which has not responded to other treatments such as medications or behavioural therapy. Sacral neuromodulation targets the communication problem by stimulating the nerves which control the bladder function with mild electrical impulses

The treatment is offered in two stages (1 & 2) which are performed under general anaesthesia. For each stage you are required to remain in hospital overnight and your urine must be free from infection. A request from for a urine pathology will be given to you before each stage. This test must be done 5 days before your scheduled theatre time. This is to enable enough time for pathology to culture and provided sensitivities before antibiotics can be prescribed. If you have a urine infection, you must have at least two days of antibiotics before your scheduled theatre time.

Stage 1 involves inserting a lead (thin wire) in your sacral area above your buttock to the S3 foramen. This is connected to a temporary soft wire which is then attached to a small external temporary neurostimulator. You can discretely hide this under your clothing. You will usually have 2 very small incisions (<1cm each), and 1 incision approx. 3-4cm on your upper buttock area. You will be offered pain relief if you require it.

A relevant staff member will see you after your procedure and will provide you with instructions on how to use the external control device. You will also be provided with ongoing education and support by relevant staff following discharge.

Following the procedure, it is important to keep the sacral dressings dry. Please avoid showering or baths. A sponge bath using a flannel or body wipes is recommended.

You will return to the rooms approximately two weeks following the first stage to assess the effectiveness of treatment. You will be asked to complete a bladder diary before this. On arrival in the rooms, you will be asked to empty your bladder and a residual ultrasound will be performed to assess how well you are able to empty your bladder.

If stage 1 is unsuccessful, the lead and external wire will be removed in theatre. This is a brief procedure.

If stage 1 is successful, you will be scheduled for stage 2. All external lines are removed and the lead is connected to the battery component known as a neurostimulator (or implantable pulse generator) that is placed beneath the skin in the outer buttock. This is a minimally invasive procedure.

You are given an external patient programmer that works similar to a remote control. You will be able to turn the stimulation up and down/ on and off. A relevant staff member will continue to provide education as required and support using the device.

Following stage 2 you will return to the rooms in 4 weeks for review by your doctor. You will be asked to complete another bladder diary for three days. On the day of your appointment, you will be asked to empty your bladder and a bladder ultrasound residual will also need to be performed to check the effectiveness of bladder emptying.

Please note: You are NOT allowed to have a full Body MRI. A head MRI is allowed but using 1.5T and the device must be turned off. Warringal Private Hospital has the specific machine that is required. If you ever have to undergo surgery, you need to show your surgeon your sacral neuromodulation identification card. Switch off your therapy before your surgery. You are not allowed to have certain types of diathermy (deep heat treatment from electromagnetic energy)

Risks following stage 1 or stage 2

• Infection
• Bleeding
• Dislodgement of wire
• Pain at implant sites
• Device problems
• Undesirable changes in bladder and bowel function

Please call the rooms if you think you have developed any of the following from Stage 1 or Stage 2 procedures:

• Skin irritation
• Infection
• Device problems
• Pain at the implant sites
• Uncomfortable stimulation
• Lead movement.