Neuromodulation is a treatment for both overactive bladder syndrome and recurrent urinary retention. It involves the insertion of a type of “bladder pacemaker” and the treatment is usually an initial test phase followed by insertion of a permanent stimulator if the test phase is successful. This is a reversible treatment which is only effective during periods of stimulation.
What does the procedure involve?
This procedure involves an initial test phase to stimulate the nerves that control some aspects of bladder function – these nerves are situated in front of the sacrum (lower back). If the test is successful, at a later date a permanent lead is placed into the sacrum and attached to a permanent nerve stimulator which is inserted into the buttock area.
What are the alternatives to this procedure?
For overactive bladder symptoms: bladder re-training, physiotherapy, drug treatment, Botulinum toxin injections into the bladder, bladder enlargement or replacement using bowel, urinary diversion into a stoma. For symptoms of urine retention: permanent or intermittent catheterisation.
What should I expect before the procedure?
After attending a pre-admission clinic before your operation date you will usually be admitted on the day of your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse. You will be asked not to eat or drink for 6 hours before surgery as a general (full) anaesthetic is necessary. You may be given an injection under the skin of a drug (tinzaparin) that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the leg veins.
What happens during the procedure?
Neuromodulation involves several stages of treatment. During the first admission, a temporary test electrode is placed into one of the sacral nerves in your lower back. The test electrode is connected to a device which generates electrical impulses for 7-14 days. During this time, you will be at home and will be asked to complete an input/output chart. The electrode will then be removed and the results discussed with you. If the initial test shows that the stimulation does alter bladder function, you may proceed to permanent implantation of an electrode and impulse generator.
The second admission will involve a general anaesthetic. During the surgery, a permanent electrode will be implanted into the sacral nerves in your lower back and a permanent generator will be placed in your buttock area. This is sometimes carried out in two stages with a 4 week period between them.
What happens immediately after the procedure?
Post operatively your implant will be switched on and programmed so that you obtain maximum benefit with regard to your symptoms whilst ensuring maximum comfort for you. When the implant is switched on, you will feel a tapping sensation in the genital or rectal area. For the test phase of Neuromodulation you will be connected to a device which generates electrical impulses. We will teach you how to use this device and provide you with contact details should you need any further support.
If the test lead is successful, a further admission for insertion of a permanent lead will be arranged and four weeks later for insertion of the permanent stimulator. This will then be switched off to allow healing and arrangements will be made for you to attend a further four weeks following insertion for the permanent stimulator to be activated. Your Specialist Nurse will activate and programme your stimulator for you and will also teach you how to control your stimulator. It may take several visits to get the right programme settings for your symptoms.
Are there any side effects?
Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
You will require surgery in the future to replace the stimulator as this will last on average for five years. You may require surgery in the future to replace, relocate or remove the lead or implant. You may notice an adverse effect on bowel function.
What should I expect when I get home?
When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge. If you have problems however, please contact your named Specialist Nurse.
What else should I look out for?
If you experience any flu-like symptoms, redness/throbbing in the wound, pain/burning when passing urine or difficulty passing a catheter, please contact your GP. Your Specialist Nurse will maintain contact throughout your Neuromodulation treatment. Over time, the body can become conditioned (used) to the programmer settings and you may need advice on re-programming.
What if I need any more information or advice?
Your Specialist Nurses will keep in contact with you after your discharge from hospital and you will have an outpatient review appointment within 3-6 months once your permanent Neuromodulation is activated.
