Sacral neuromodulation

Stress incontinence

Sacral neuromodulation is a new treatment for women with urgency and urge incontinence. Over 30 per cent of women will experience problems with continence, typically after childbirth and menopause, although younger women can also be affected.

Also known as sacral nerve stimulation, electrical currents are used to reset the faulty nerves causing bladder dysfunction.

“Sacral neuromodulation is a very important new breakthrough in the treatment of the overactive bladder. It provides an effective solution for women when conservative treatment has not worked. It avoids the risk of catheters with major surgery.”

Jeremy Ockrim, Consultant Urologist, Harley Street Urology

What does the sacral neuromodulation treatment involve?

The first step is to have a simple test procedure to see whether neuromodulation is effective for you.

The nerves are located in the lower back, adjacent to the sacrum. Under a local or short general anaesthetic, the surgeon uses a small needle to place a thin wire in contact with your sacral nerves. The other end of the wire is taped to the outside of your back and connected to a temporary stimulator control unit, which is worn on your belt. The temporary stimulator is worn for three weeks to assess your response. The approach works well for approximately 70 per cent of patients.

If you find the treatment effective, you will be asked to come into hospital again to have a permanent implant. This a much smaller device – the size of a £2 coin – which is implanted under the skin and fat of the lower back so it cannot be felt. You will not have to have anything attached to your back or any external device. A control unit, the size of a mobile phone, is used to change and control the frequency of electrical signals and you can keep this at home.

The procedure is carried out under general anaesthetic, although you will probably be able to return home on the same day.

How does the treatment work?

This treatment is sometimes referred to as the ‘pacemaker for the bladder’. A traditional cardiac pacemaker is a device implanted inside the body which and sends electrical currents to the heart, correcting faulty heart rhythms.

In the ‘overactive bladder’ the sacral nerves send unwanted messages to the bladder, causing it to contract suddenly (urgency) and empty without due warning (urge incontinence). Sacral neuromodulation works be interrupting this ‘faulty circuit’ and restores normal communication between the nerves, brain and the bladder. There is no need for repeat treatment, and there is little risk of requiring catheters to empty your bladder. The battery in the permanent implant is effective for up to seven years.

How does it feel?

The implant is very small and placed underneath the fat of the lower back/upper buttock area. The surgeon makes a small incision of about 3cm to insert the device during surgery, so recovery is quick and straightforward. The device is cushioned by the body’s fat and so you will not be aware that you have any implant in that area. Patients say they are sometimes aware of the device when they lie in certain positions, but they do not report feeling any discomfort.

The electrical stimulation is kept below detectable levels and the patient is not aware of the stimulation unless the pulses are turned up. There is usually an initial period of the first few weeks after the implant is inserted when you get used to the device and find the right level for you.

Sacral neuromodulation is also used to treat bowel frequency and urgency – a problem that is often associated with overactive bladder. It is also reported to help sexual dysfunction and improve sexual sensitivity for women.

We will provide you with continuous support to ensure you are happy with the device and it is effective for you.

Advanced urology nurse specialist Julie Jenks

“We have been amazed at our patients’ responses to the new technique. The implant has revolutionised their lives and allowed them to return to social activities, where they had previously lost confidence. We offer continued after care to adjust the device settings according to our patients’ individual needs.”

Julie Jenks, Advanced Nurse Practitioner, Harley Street Urology

What is the evidence for this treatment?

Sacral neuromodulation was first described in 1998 and now has 10 years of accumulated evidence establishing its effectiveness and safety. It was approved by NICE (National Institute for Health and Clinical Excellence) in 2003 and is widely used in Spain, Holland and Germany. However, the technique has not been widely available in the NHS due to cost and limited expertise available in the UK.

How effective is it?

Harley Street Urology’s bladder specialist consultant Jeremy Ockrim and nurse specialist Julie Jenks working together have one of the largest experience of sacral neuromodulation for bladder dysfunction in the UK. Jeremy Ockrim is the lead specialist for neuromodulation and bladder dysfunction at Harley Street Urology and University College Hospital, London. Together, they have treated over 50 patients in the last 12 months and have many more waiting; with the majority finding their urgency and incontinence has significantly improved or ceased, and over 70 per cent proceeding to the permanent implant after a test stimulation.