Care at NUH

Services for Sacral Neuromodulation

What is ​sacral neuromodulation?

Sacral neuromodulation, also known as Sacral Nerve Stimulation is a procedure involving the placement of a wire in the lower back, near the nerves that control the bladder and bowel functions. This wire delivers small electrical pulses to improve problems with bladder and bowel functions. 

What are the alternatives? 

  • Conservative treatments 
  • Incontinence pads: For less bothersome symptoms, the option of using incontinence pads to manage urine leakage is available.  
  • Conservative measures: Incorporating lifestyle changes such as weight loss, improved fluid intake and reduced caffeine and alcohol consumption.  
  • Bladder training: Learning techniques to resist the urge to pass urine and improve control. 
  • Medicines: If conservative treatments prove ineffective, medications may be considered. 
  • Sacral nerve stimulation is usually explored when other treatments have not yielded satisfactory results Alternative procedures to sacral nerve stimulation include: 
  • Botulinum toxin-A injections into the muscles lining the bladder wall using a cystoscopy 
  • Posterior tibial nerve stimulation (PTNS): Electrical stimulation of a nerve near the ankle. 
  • Enterocystoplasty: A major operation that enlarges the bladder. 
During the procedure

The sacral neuromodulation procedure is performed in two separate operations, usually a few weeks apart. 

First Operation: Temporary Stimulator Placement 

  • Conducted under sedation or general anesthesia. 
  • Involves a small incision in the lower back and a second 3-4 cm incision in the upper buttock. 
  • Placement of an electrode (wire) near the nerves, guided by X-rays to ensure accurate positioning. 
  • The wire exits through the skin at the side of the buttock. 
  • Connection of the wire to a stimulator box located outside the body. 
  • The stimulator box emits electrical signals to the nerves and is worn continuously. 

Services for Sacral Neuromodulation

Trial Phase 

  • Typically spans 2-4 weeks. 
  • Assesses the effectiveness of the temporary stimulator. 
Second Operation: Permanent Stimulator Implantation or Removal 

  • Based on the success of the trial, the second procedure is performed. 
  • Options include implanting the permanent stimulator or removing the temporary one.
What are the risks and side effects?
  • Failure of the treatment to improve symptoms significantly (common). 
  • Mild discomfort requiring simple painkillers (rare). 
  • Need for replacement, relocation or removal of the implanted stimulator or electrode (rare) 
  • Discomfort in the buttock or lower back, at the site of the stimulator or its lead (rare) 
  • Discomfort in the ankle or foot (rare) 
  • Infection in the wound requiring antibiotics and possible removal of the device (rare) 
  • Stimulation produces an adverse after-effect on bowel functions (rare) 
Other important information

Battery life 

The battery in the stimulator typically lasts for 3-7 years. Changing the battery is relatively simple, resembling the second stage of the initial implantation. 

Sports and strenuous activities 

To minimise the risk of damaging or dislodging the stimulator or the wire, it is advisable to refrain from engaging in contact sports, extreme sports or horse-riding. 

Electronic devices 

Security screening and airport scanning devices can affect the stimulator. Displaying the stimulator identification card to security staff may allow you to bypass the scanner. Alternatively, turning off the simulator before passing through the scanner is an option. 

MRI scanning 

After the implant, it is not recommended to undergo an MRI scan, except for head scans. However, some newer devices are MRI-compatible, and this should be discussed with your doctor. 

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