Sacral Neuromodulation

Sacral Neuromodulation

Sacral neuromodulation (SNM) is an FDA-approved treatment for overactive bladder, urgency or mixed urinary incontinence and non-obstructive urinary retention for people who have failed or are unable to tolerate treatments such as medications (anticholinergics or beta-3 agonists). A small, thin power source pulse generator is implanted under the skin of the upper, outer aspect of your lower back/hip area. Using specialized, minimally invasive techniques, this device is connected to a thin wire which is runs deep in the fatty tissues above your buttock muscles and ends near your sacral spinal nerves (generally S3). The leads deliver gentle and targeted electrical stimulation pulses to the bladder nerves which can be easily adjusted to optimize your individual results. In doing so, most patients gain enormous symptomatic improvement from their bothersome urinary symptoms, thus restoring their dignity and significantly improving their quality of life. SNM technology provides you robust and durable symptomatic relief without having to deal with bothersome side-effects of medications such as dry mouth, constipation, blurry vision and confusion.

Is this technology new?

No. Electrical stimulation of nerves to achieve muscle contractions has roots that date back to the 1700s. Deep brain stimulation to treat chronic pain began in the early 1960’s, thereby starting the modern era of neurostimulation and SNM to treat bladder dysfunction has been widely adopted and used since the late 1990s. This technology has been applied to other areas of medicine such as in the treatment of chronic complex regional pain, epilepsy, chronic migraine and Parkinson’s disease.

Will SMN work for me?

Before committing to receiving a full SMN implant, Dr. Horovitz will first assess how your bladder responds to this technology by performing a simple in-office simulation test. During this session, very small leads, a little thicker than a head of hair, are carefully placed near your bladder nerves while you are awake using local anesthesia (freezing). These leads are connected to an external pulse generator (outside of your body). You are sent home with this device and will follow-up with Dr. Horovitz 3-5 days later so that he may assess your response to the test. At this follow-up meeting, Dr. Horovitz will remove the temporary device in a simple, pain-free manner. He will review your bladder voiding diary and will ask you questions about your experience during the test. Generally, if your symptoms have improved by greater than 50% in the domains of urinary frequency, urgency, incontinence episodes or number of nighttime voids, this is an indication that a full SNM implant might be warranted- (most people report much greater responses than 50%. Having experienced the technology for several days, you may then make an informed decision about whether or not you would want to have a permanent SMN implanted at a later date.

What other options for my overactive bladder if the medications aren’t working?

Other treatments exist such as Botox or percutaneous tibial nerve stimulation (PTNS). However, Botox requires uncomfortable serial retreatments under cystoscopic guidance every 3-6 months to maintain its efficacy. Botox also risks putting you into urinary retention, requiring self-catheterization until the medication wears off. PTNS requires you to return to you doctor’s office weekly for 30-minute sessions for 12 weeks followed by maintenance sessions every 4-8 weeks; clearly, this schedule can be burdensome and disruptive to your daily routine. Any positive effect you gain from PTNS will dissipate once you stop receiving maintenance treatments. In contrast, SNM is a permanent solution with little maintenance once your optimal settings have been established. The device can generally last for 15 years without requiring these types of repeat treatments.

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