- Trans-Urethral Resection of the Prostate
- Robotic Assisted Prostatectomy
- Open Radical Prostatectomy
- Drug Treatment for BHP
- Transurethral Incision of the prostate
- Open Prostatectomy
- Trans-Urethral Resection of Bladder Tumour
- BCG treatment
- Electrical stimulation of the pelvic floor
- Injections for OAB
- Sacral Nerve Stimulation
- Bladder Augmentation
- Suprapubic Catheter
- Tension-free vaginal tape (TVT)
- Trans Obtutrator Tape (TOT)
- Urinary Diversion
- Vaginal Mesh Support
- Percutaneous Nephrolithotomy (PCNL)
- Genitourinary medicine
- Sexual health
Sacral Nerve Stimulation
Nerve stimulation by a treatment called Sacral Neuromodulation can help some people control their overactive bladder (OAB). The treatment is a success for many people, however, it is not suitable for everyone and your doctor or health professional should advise you carefully about this.
Neuromodulation is a reversible option that can immediately reduce and even eliminate the symptoms of overactive bladder, including urge incontinence, urgency-frequency, and urinary retention.
Neuromodulation is also indicated for bowel incontinence and can be used to treat both bladder problems and bowel problems at the same time.
What does it involve?
A small device, similar to a pacemaker, is surgically implanted just beneath the skin in the upper buttock. It is called a Neurostimulator. It's about the same size of the face of a typical stopwatch (44 mm high, 51 mm long and 7.7 mm thick). A thin wire is implanted in the lower back and connected to the device.
This device acts as a battery and stimulates the appropriate nerves via the implanted wire by using mild electrical impulses.
By doing this, it can help restore coordination between brain, pelvic floor, bladder or bowel and sphincter muscles.
What does Sacral Neuromodulation treat?
Sacral Neuromodulation may effectively treat overactive bladder. It may alleviate leaking and the frequent, strong, and sudden urge to go to the toilet. It may also alleviate symptoms of retention that are not caused by an obstruction. In some cases, it may alleviate symptoms of interstitial cystitis.
Sacral Neuromodulation may also treat faecal incontinence and chronic constipation in some patients.
Sacral Neuromodulation is a therapy that's used when more conservative options (such as dietary changes or biofeedback) haven't worked or are too difficult to live with. A doctor will assess each patient's suitability for the treatment.
How do you know it will work for you?
Sacral Neuromodulation is performed in two stages, the first is an evaluation/test phase and the next is the implant phase. The evaluation phase allows your doctor to assess whether or not you will benefit from Sacral Neuromodulation.
Before any of this though, you'll spend a few weeks at home recording your toilet habits in a diary form to use as a base for future comparison.
A thin temporary wire is inserted near the nerves in your lower back, the so called sacral nerves that control the bladder. The wire is then connected to an external battery which delivers mild electrical pulses to the nerves. This external battery is worn on a belt for the duration of the evaluation. The surgical procedure normally takes less than an hour and is generally done as a day case.
After the temporary wire is inserted you'll go home and go about your daily life, continuing to record your toilet habits during this test in a new diary.
After several days of the home evaluation, your doctor will explain the results to you. Several measures will be used to assess whether or not you will benefit from Sacral Neuromdulation. These include recording the number of incontinence episodes before and after the test, quality of life assessments, and patient satisfaction.
Following a positive evaluation, a permanent battery will be surgically placed.
Should your evaluation be a failure, the temporary wire will be removed in clinic and your specialist will either consider repeating the test or discuss other options with you.
The science behind Sacral Neuromodulation
One way the brain controls our body's muscles and movements is through electrical messages, which are carried by nerves. These nerves have major routes with smaller pathways running off them.
One major route runs from the brain, along the spinal cord and through the lower back called the sacral area. Here, nerve paths split off and go in different directions, some to the pelvic area. The muscles in the pelvic area, such as the pelvic floor, urethral sphincters, bladder and anal sphincter muscles are controlled by the brain through nerves that run from the sacral area. Our sensations, such as fullness in the bladder or rectum, are also relayed to the brain via these nerve routes.
Sacral Neuromodulation helps to correct inappropriate, unwanted or even erroneous messages sent along these nerve pathways.