Sacral Neuromodulation

Sacral Neuromodulation (SNM), which you may see advertised under the brands Axonics® from Boston Scientific or Interstim® from Medtronic, is a relatively newer technology and represents a more permanent option for patients with overactive bladder (OAB). Before sacral neuromodulation, the patient only had less permanent options for their OAB, including percutaneous tibial nerve stimulation (PTNS), which needs 12 weeks of initial treatment followed by monthly maintenance treatments in perpetuity. Bladder Botox, a semi-permanent option, has also been available for quite some time, but here still, patients require re-treatment every 6 to 9 months. While the treatments mentioned above are very effective for overactive bladder, sacral neuromodulation introduces a permanent option that can last up to 20 years with relatively few side effects.

How Sacral Neuromodulation Works

Simply put, sacral neuromodulation is equivalent to placing a pacemaker, only we regulate the bladder. A small pulse generator, similar in shape and size to a pacemaker, is implanted in the lower back, and electrodes are appropriately placed to deliver low-level electrical pulses to modulate or control bladder function. This procedure is performed under local anesthetic or sedation and represents a minimally invasive way to improve symptoms.

The Trial

One of the great benefits of sacral neuromodulation devices is that they can be tried beforehand. When patients are first offered this therapy, we use an external pulse generator to stimulate the nerves. For most, this offers excellent results almost immediately. Once we are happy that the nerve stimulator route will be successful, we remove the temporary leads and schedule the patient for surgery. Even if the trial fails, advanced lead placement testing often allows patients a good chance of success with the permanent device.

Postoperative Recovery and Considerations

Recovery from implantation of a sacral neuromodulation device is very straightforward. Most patients experience discomfort but not significant pain, which is usually well-managed with over-the-counter pain medication. 

The permanent implant is adjustable, so the patient will be asked to return for one or two follow-up appointments. A technician will further adjust and refine the electrical impulses during these appointments based on results gathered and patient satisfaction.

Improvements in medical device technology mean that these devices are better made and longer-lasting. Patients may choose between a rechargeable option or a single-use, long-lasting battery. The lifespan for both devices is comparable at about 15-20 years, depending on the usage load. Once the battery is spent, a simple procedure to replace the pulse generator can be performed, which is far less invasive than the original procedure.

Next Steps

The next step is to speak to a qualified men’s health urologist like Dr. Natale to understand your options for overactive bladder treatment. We often see patients who have suffered from the symptoms of overactive bladder for years or even decades, not realizing that we have viable options that not only offer relief but do so in a very satisfactory way. Scheduling an appointment is the first step toward relief.

We look forward to helping you manage your Overactive Bladder and any other urinary symptoms you are experiencing.