How Does Sacral Neuromodulation Work?
Sacral Neuromodulation is a therapy that provides gentle stimulation to the nerves that control the bladder and bowel. The stimulation can restore normal communication between the brain and the bladder and/or bowel, which can result in an improvement of your overactive bladder, bowel incontinence, and urinary retention systems.
Will Sacral Neuromodulation Therapy Cure My Symptoms?
Sacral Neuromodulation therapy is not a cure, but it is a long-term therapy that may provide significant relief of your symptoms.
How Do I know if Sacral Neuromodulation Is Right for Me?
Sacral Neuromodulation is a safe and effective treatment, indicated for people suffering from overactive bladder, bowel incontinence, and/or urinary retention who have not found relief with previous treatments. Seek advice from your Georgia Urology physician to see whether Sacral Neuromodulation is right for you.
Will This therapy Help with my Stress Incontinence?
No, this therapy will not help with stress incontinence.
What Makes the Axonics System Different from Other Options?
It is the only advanced therapy for overactive bladder, bowel incontinence, and urinary retention that is rechargeable and designed to last in the body for at least 15 years. Sacral Neuromodulation is also the only advanced therapy shown in a clinical study to produce greater symptom reductions and improvements in quality of life than oral medication. Another advantage is that there is a 14-day trial period to ensure the Axonics Systems is right for you. At the end of the trial period, you and your doctor can decide what your next treatment steps are.
How Long Does the Relief Last?
Your Axonics System can provide you with therapy that lasts for at least 15 years.
InterStim Therapy System
InterStim Therapy is a treatment option that may relieve bladder or bowel control issues in people who have not had success with or could not tolerate other treatments. It was created by Medtronic, the developer of the pacemaker, and has been FDA approved since 1997 for urge incontinence, and since 1999 for urinary retention and urgency-frequency.
How Does InterStim Work?
InterStim Therapy is a proven therapy that works by targeting the communication problem between the brain and the nerves that control the bladder and bowels. If those nerves are not communicating correctly, the bladder will not function properly. InterStim uses mild, electric pulses to reduce the signals to the nervous system which may be causing problems such as leaks, the sudden urge to go, or going too often.
InterStim Therapy’s Peripheral Nerve Evaluation
You and your doctor may decide to try InterStim Therapy by going through test stimulation known as a peripheral nerve evaluation. With InterStim’s Therapy’s two-step process, you can test it out to see if it works for you before making a long term commitment. The peripheral nerve evaluation allows you to experience the effects of InterStim Therapy at home for a short period of time. Your doctor will discuss the peripheral nerve evaluation procedure with you and the options for using either a temporary lead or long-term lead for the test. One end of the lead is implanted near your sacral nerves and the other end is connected to a small external test stimulator that can be worn on a belt. The stimulator generates mild electrical pulses that are carried to the sacral nerve by the lead. While you wear the test stimulation system you will need to complete a diary to record how the stimulation affects your symptoms.
At the end of the evaluation period, you and your doctor will decide if an InterStim Therapy system is a right choice for you. Based on the results of the evaluation, you and your doctor will determine the next step that is right for you.
What Happens During The Evaluation Procedure?
The procedure is done in our Ambulatory Surgery Center (ASC) and usually takes less than 1 hour to complete. You may want to bring a spouse, relative, or friend to provide support during the procedure. Your doctor will give you local sedation so that you can provide feedback during the procedure. During the procedure, your doctor will insert a needle just above your tailbone to locate the appropriate sacral nerve. When the needle is in place, the test stimulation system will be turned on and your doctor will ask you to describe what you feel. Some people feel a “pulling” or “tingling” sensation in their pelvic muscles or big toe. Women may feel a sensation in the vaginal area; men in the scrotum.
The sensation of stimulation should not be painful. Most people describe it as a slight pulling or tingling in the pelvic area. If you experience any pain during the evaluation period, turn the test stimulator down or off and notify your doctor or nurse.
What to Expect After the Evaluation Procedure
- Take it easy; keep your activity level low to moderate during the test period.
- Avoid bending, stretching too much, or lifting heavy objects more than 5lbs.
- Sponge bath only. Avoid bath, showers, and hot tubs. Do not submerge your body in water.
- There will be small dressing over-insertion areas. Do not remove. You can reinforce with another dressing. Keep bandages dry and intact. A small amount of blood is normal.
- If you experience any fever greater than 101.0 or severe pain, please call Georgia Urology and notify your doctor.
- You will receive a follow-up call from Georgia Urology staff member and a Medtronic Representative.
- Please be sure to call the office and make a follow-up appointment as directed by your doctor.
Keeping a Diary During the Test Stimulation Period
You will be asked to keep a diary during the evaluation period to track your bladder control symptoms. This history will help your doctor evaluate whether an InterStim Therapy system is right for you.
How Will I Know If InterStim Therapy Works For Me?
Generally, if your symptoms improved and you didn’t experience any problems during the evaluation period, then you and your doctor will discuss whether to proceed with a long-term InterStim Therapy system.
Common Questions about InterStim Test Stimulation
I’m not sure if the stimulation is working. What should I do?
Check the battery and the ON light to be sure the test stimulator is working. If it is, turn the amplitude dial to OFF and gradually turn up the stimulation to a comfortable setting. Call your doctor if you have any questions or are still unsure that the test stimulator is working.
What does the stimulation feel like?
Stimulation varies from person to person, but most people describe it as a slight “pulling” or a “tingling” sensation in the pelvic area. It should not be painful. If you feel any pain, turn off the test stimulator, and call your doctor.
Will the test stimulation cure my condition?
No. The test stimulation is temporary. It is a tool that helps determine whether an InterStim Therapy system is right for you. Once the lead is removed, your original symptoms will return. If you have had positive results with the test stimulation, then you and your doctor may decide to use a long-term InterStim Therapy system to treat your symptoms.
Will the stimulation change at all?
You may feel slight stimulation changes when you move from a sitting to a standing position or from a standing to a walking position. Check with your doctor; you may need to adjust the stimulation when that happens.
Will stimulation hurt my nerves?
No. Research has shown that the nerves are not harmed by the stimulation when used properly.
How long will the battery last?
Your test stimulator will have a new 9-volt battery when you go home. It should last for the entire test stimulation period. However, you can change the battery, if necessary, by opening the battery door on the back of the device. Turn off the test stimulator before removing the batteries (and do not leave the battery compartment of the test stimulator empty for any long periods of time). When the new battery is in place, close the battery door and slowly turn up the stimulation setting to a comfortable level.
Can I have sex during the test stimulation period?
No, you should avoid sexual activity during the test stimulation period because it could cause the lead to move. This restriction only applies to the test stimulation period, there are no restrictions on sexual activity during long-term InterStim Therapy.
- A piece of small bowel is reflected and sutured onto an opened bladder to create an “augmented “or strengthened bladder.
- Overactive bladder contractions disappear over this larger area and become less symptomatic and less dangerous to the kidneys.
- Some patients may need to learn to do intermittent self-catheterization if the bladder does not empty well.
- The bowel segment of the augmented bladder will continue to produce normal mucous which will mix in with normal urine.
- There is an increased risk of bladder stone formation.
- Routine yearly cystoscopy is done as there is a very small risk of the augmented bowel segment undergoing malignant transformation over time.
- This is usually done as a last option.
- Urine can be surgically diverted by implanting the ureters (tubes draining the kidneys to the bladder) to a piece of small bowel. This then exits to the abdominal skin surface (stoma) into a bag.