Advanced, Effective, and Safe OAB Therapy
Sacral neuromodulation (SNM) is an advanced therapy for overactive bladder (OAB) that uses a small, pacemaker-like device implanted in the lower back to deliver gentle electrical stimulation to the sacral nerves, which helps regulate bladder function. This treatment is typically considered when conservative approaches such as lifestyle changes, pelvic floor therapy, and medications have not provided sufficient relief.
Other advanced therapies, including Botox® injections, percutaneous tibial nerve stimulation (PTNS), and implantable tibial nerve stimulation, may also be considered depending on your symptoms and treatment goals.
Overactive bladder patients at Georgia Urology are introduced to our proprietary OAB pathway, ensuring exceptional, tailored care. We recognize that each case of overactive bladder is different; thus, there is no one-size-fits-all solution.
With a network of nurses, staff, and urologists available to our patients, we track patients through their treatment and journey, adjusting as necessary and optimizing their care for long-term relief.
One of the most compelling benefits of choosing sacral neuromodulation is that patients can trial the device with a simple and short in-office test to see if it will help. During the trial, an external battery is connected to temporary leads (thin wires) that are placed near the appropriate nerve bundles. The trial period typically lasts 4-5 days, during which time patient data is collected to determine whether the trial was successful.
After a successful trial phase, the temporary leads are removed, and the patient can be scheduled for surgery. Even if the in-office test fails, we can employ more advanced lead placement tests that often result in a successful final result.
Sacral neuromodulation surgery involves implanting a small battery in the lower back that is connected to a permanent lead, which stimulates the appropriate nerves. The battery can be rechargeable or recharge-free. The entire surgery is performed under sedation at a hospital or an ambulatory surgery center. Most patients are up and about quickly after surgery.
Discomfort after surgery is often described as mild and easily controlled with over-the-counter pain medication. A few postoperative considerations include proper wound care and minimal strenuous activity for up to a week or until cleared by the surgeon.
Sacral neuromodulation is reserved for patients who have not experienced significant improvement after conservative therapies. It effectively reduces the symptoms of OAB and has been shown to significantly improve symptoms in many patients. In addition, because it is a permanently implanted device, patients do not have to come back to the office for repeat treatment.
Sacral neuromodulation has satisfaction rates similar to BOTOX but does not require a follow-up procedure every six months or so. Learn more about BOTOX for OAB
Percutaneous tibial nerve stimulation uses a similar principle to SNM, but rather than directly stimulating the sacral nerves in the lower back, it does so indirectly by stimulating a nerve in the ankle. While PTNS is less invasive, it requires monthly maintenance visits after an initial 12-week therapeutic period. Learn more about PTNS for OAB
In addition to sacral neuromodulation, newer implantable therapies are available that provide tibial nerve stimulation without the need for frequent office visits. These include the eCoin Peripheral Neurostimulator System and the Altaviva System.
These minimally invasive options are placed near the ankle and deliver ongoing stimulation to help reduce urgency, frequency, and leakage associated with an overactive bladder. They may be appropriate for patients seeking an alternative to traditional PTNS or sacral neuromodulation.
As with any surgical procedure, no matter how minor, there are some associated risks, most of which revolve around pain and infection. Each of these can be minimized by employing a highly skilled and experienced surgeon and following post-op instructions closely. In addition to the surgical risk, there is an uncommon risk that the stimulator does not function correctly, which requires replacement and/or removal. Also rare is when the stimulator does not offer as much relief as the trial, though this is often solved with programming the device.
The stimulator can last up to 15 years, depending on the setting. At this point, the battery can be easily replaced in a minor follow-up surgical procedure. Rechargeable batteries require a simple charge every few months.
There is also a small risk of lead damage or migration, requiring a follow-up procedure to reposition them.
There are multiple sacral neuromodulation systems available, including the Axonics Sacral Neuromodulation System and the InterStim System.
Both devices are designed to deliver gentle electrical stimulation to the sacral nerves to help improve bladder control. While they differ slightly in design, features, and battery type, they offer similar clinical outcomes. Your provider will help determine which system may be the best fit for your individual needs and preferences.
To learn more about our overactive bladder treatment program, we encourage you to schedule a consultation with one of our urologists. Remember, while overactive bladder is very common, you do not need to live with its symptoms any longer. Getting relief is just around the corner, and we look forward to being a part of your care.
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