This is a procedure in which a tiny electrical wire (electrode) is placed through the skin into the lower portion of the pelvic bone (sacrum) that then delivers a minute electrical charge to the nerves that go to and from the bladder. By stimulating this nerve with an individually programmed electrical impulse, the bladder will often return to normal function. Sacral nerve stimulation can successfully treat a high percentage of patients with overactive bladder, frequent urination, urgent urination, urge incontinence, urinary retention (inability to urinate or completely empty the bladder), and fecal incontinence (inability to hold one’s bowel movements).
Candidates for InterStim neuromodulation are patients with the above mentioned symptoms who have failed adequate trials using at least two traditional medications. There are usually two steps in the process of undergoing this procedure. The first step is a nerve evaluation which can be performed in the office, but which is more commonly performed in an operating room setting.
In this procedure, a small amount of numbing medicine is placed in the lower portion of the back just above the tailbone and, with the help of x-ray guidance; a small needle is placed, passing through a small opening in the pelvic bone. A small test wire is then placed through this needle and brought out through the skin where a bandage is placed. This wire that is attached to a small electrical device, about the size of a cell phone, that will deliver the electrical stimulation to the nerve. The patient wears this device for approximately three days and then returns to the office to report the changes in his or her symptoms.
If the patient finds that they have had significant improvement, they subsequently can proceed with the second step of the procedure, which is a more permanent implantation. This second step is performed in an operating room setting as an outpatient. The steps of the procedure are also very similar, but the wire that is placed in the pelvic bone is instead kept under the skin and tunneled to a small area in the hip region where an electrical generator is placed. This device is very similar to a pacemaker that has been used for years for cardiac patients. With neither the first step nor the second does a patient have to be full anesthetized (put to sleep).
What is the purpose of InterStim Neuromodulation?
While symptoms can often be treated successfully with traditional therapies, approximately 20% of patients fail to respond to medical therapy. Additionally, some patients developed significant side effects from their medicine, and therefore cannot maintain medical therapy chronically. By providing a low level stimulation to the nerve that comes from the bladder to the spinal cords, bladder symptoms can be relieved in 70% without using traditional medications.
What are common symptoms following my InterStim implant?
Most patients do very well following InterStim placement with minimal side effects and symptoms. Common symptoms may include bruising in the skin where the implant wire is placed or where the generator is placed in the hip region. A small amount of bloody or clear discharge from either one of these sites is also very common in the first week following the procedure. Depending on the power level that is programmed for the stimulator, the patient’s may feel a fluttering sensation or dull ache in the perineal region.