Sacral Neuromodulation delivers continuous stimulation to the sacral nerves innervating the organs of the pelvis, located at the sacrum. These sacral nerves control the urinary and digestive systems, as well as the pelvic floor muscles.
A sacral neuromodulator is an implantable device that generates gentle electrical impulses which are transmitted to an electrode, positioned close to the third sacral nerve.
The aim of this therapy is to restore communication between the brain and the bladder and/or between the brain and the digestive system, for the management of voiding and fecal disorders1,2,3.
The test or evaluation phase
The final implantation phase
Test phase
Evaluation is a temporary phase designed to check whether the therapy works for the patient. The goal is to improve quality of life and reduce symptoms, which corresponds to: a reduction in the number of incontinence episodes, a reduction in the number of voids and an increase in the time between urinations.
How is the surgery performed?
In the test phase, a thin wire electrode is inserted into the lower back, close to the sacral nerves that control the bladder and bowel. At the end of the surgery, the lead is connected to an external and temporary stimulator which will stimulate the sacral nerves.
What happens after the operation?
Before and during the test phase, patients will be asked to monitor their symptoms to check the effectiveness of the therapy.
How can the effectiveness of the therapy be measured?
At the end of the evaluation phase, the patient will meet with a member of the medical team to review the bladder or bowel diary, check whether symptoms have been reduced, and decide whether the therapy is suitable.
If the patient is not satisfied, the electrode is removed and treatment stops.
If the test has worked for the patient, a member of the team will see him/her to discuss how the neuromodulator will be implanted.
Permanent implantation phase
There are different sacral neuromodulation systems: rechargeable and non-rechargeable. The device best suited to the patient's needs will have been determined before the test phase with the medical team. Regardless of the option chosen, the permanent sacral neuromodulation system consists of 2 components: an electrode and a neuromodulator. These components are implanted under the skin.
How is the surgery performed?
The neuromodulator (which produces the electrical impulses for stimulation) will be placed beneath the surface of the skin, in the upper buttock and connected to the lead.
What happens after the operation?
Many people don't feel the stimulation on a daily basis; if the therapy is working, this is perfectly normal. The goal is to achieve the most effective reduction of symptoms possible, without adverse effects, at minimal stimulation levels. An annual follow-up is recommended.
References
1
Leng, W. W. & Chancellor, M. B. How sacral nerve stimulation neuromodulation works. Urol. Clin. North Am. 32, 11–8 (2005).
2
Chancellor, M. B. & Chartier-Kastler, E. J. Principles of Sacral Nerve Stimulation (SNS) for the Treatment of Bladder and Urethral Sphincter Dysfunctions. Neuromodulation Technol. Neural Interface 3, 16–26 (2000).
3
Gourcerol G. et al. How sacral nerve stimulation works in patients with faecal incontinence. Colorectal Dis. 13(8):e203-11 (2011)
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