Sacral Neuromodulation (InterStim)
A small implanted device that restores bladder and bowel control when medication hasn’t worked — with a test phase first, so you can see whether it helps before the permanent implant.
What sacral neuromodulation is
I offer sacral neuromodulation (InterStim) in Johannesburg for overactive bladder, urge leakage and bowel control problems that have not improved with medication. A test phase comes first, and both stages are day procedures under general anaesthetic.
The sacral nerves, at the base of the spine, carry the signals between the brain, the bladder and the bowel. When those signals are disrupted, the result can be urgency, frequency, leaking, or difficulty emptying. Sacral neuromodulation (SNM) uses a small, pacemaker-like device to send gentle electrical pulses to these nerves, restoring more normal communication.
I am a Medtronic-accredited proctor for sacral neuromodulation, training other surgeons in the procedure, and I am on the faculty of the yearly InterStim cadaver workshop in Stellenbosch where new implanting surgeons are trained.
Who it can help
- Overactive bladder and urge incontinence that have not improved enough with bladder training and medication
- Urinary retention — difficulty emptying the bladder — that is not caused by a blockage
- Faecal (bowel) incontinence
It is an alternative to bladder Botox for refractory overactive bladder; we will compare the two with you.
Two stages: test first, then implant
Stage 1 — the trial
A thin lead with small anchoring tines (a staged, tined lead) is placed next to the sacral nerve and connected to an external stimulator. You then go about normal daily life and keep a bladder or bowel diary, so we can measure how much it helps.
Stage 2 — the permanent device
If the trial gives a clear improvement, the permanent device is placed under the skin of the upper buttock and connected to the same lead. If the trial does not help enough, the lead is simply removed.
Both stages are done under general anaesthetic as day cases, at any of my hospitals.
The InterStim X device
- No recharging — the InterStim X is a recharge-free device, with a battery that lasts over a decade at usual settings, according to the manufacturer
- MRI-compatible — it allows full-body MRI scans under the specific conditions set by the manufacturer
- You can adjust the stimulation yourself with a small handheld programmer, within the settings we choose together
Source: Medtronic InterStim X.
Would you like to know whether SNM could help you? Call 011 794 3549 or email appointment@urology.joburg. See also: Overactive bladder · Urinary incontinence.
This information is general in nature and is not a substitute for a consultation.