June 19, 2024
Global Sacral Nerve Stimulation

Understanding Sacral Nerve Stimulation as a Treatment Option

What is it?

Sacral nerve stimulation (SNS) is a minimally invasive treatment option that uses mild electric pulses to help control symptoms of overactive bladder, fecal incontinence, and constipation. This treatment method delivers those pulses to the sacral nerves, which help control bladder and bowel function. Stimulating these sacral nerves disrupts the abnormal signals in the pelvic floor that cause issues like urinary frequency and urge incontinence. SNS aims to restore more normal bladder and bowel control and function.

How Does it Work?

During SNS, a thin electrode lead is placed near the Global Sacral Nerve Stimulation through a small incision in the lower back, just above the buttocks. This electrode is then attached to a battery-powered neurostimulator unit implanted in the lower abdomen or buttocks area. The surgeon will first test the treatment externally for 1-2 weeks using a temporary external stimulator to ensure symptoms are improved by at least 50%. If effective, the patient returns for a 2nd surgery to switch to the implanted neurostimulator and battery.

The implanted device works by sending mild electrical pulses through the electrode to the sacral nerves. These pulses interrupt and modulate pain and urgency signals from reaching the brain. Patients control stimulation therapy by using a remote patient programmer to turn on, off, or adjust stimulation levels. Therapeutic stimulation may help relax pelvic floor muscles, normalize nerve signaling, and restore more coordinated bladder or bowel function and control.

Who Can Benefit from Sacral Nerve Stimulation?

SNS is FDA approved for treating urinary urgency incontinence, urinary frequency, and fecal incontinence when other conservative options have failed. It may benefit those who have:

– Overactive bladder symptoms like urgency or urge incontinence

– Fecal incontinence or constipation despite lifestyle changes

– These symptoms for 6 months or longer

– Failed to get adequate relief from medication, physical therapy, biofeedback, or other treatments

Important factors considered are whether symptoms improved significantly during the trial stimulation period and how committed the patient is to long-term therapy and follow-up care requirements. In some cases, SNS may provide an alternative to more major surgeries.

The Procedure and Recovery Process

Performing sacral nerve stimulation involves these key steps:

  1. Trial Stage: A thin electrode lead is placed under fluoroscopic guidance near the sacral nerves through a small incision. A temporary external neurostimulator is used for 1-2 weeks to test response.
  2. Implantation Stage: For those with a positive response, a 6-8 cm incision is made 1-2 weeks later to insert the permanent generator and lead. Tests are performed to determine optimal electrode position and stimulation settings.
  3. Programming & Follow-Up: Over time a clinician will adjust stimulation levels for best control through external programming using a laptop and patient programmer. Patients learn to change settings as needed. Regular appointments are required to check device status.

Most patients go home the same day as the permanent implant procedure. Recovery typically involves a few days of mild soreness from the small incisions. Stimulation therapy is then begun and adjusted over several weeks to months. Long-term success often depends on follow-up care and programming to accommodate changing symptoms over time.

Risks and Possible Complications

Like any implanted device and surgical treatment, there are risks associated with SNS. However, major complications are relatively rare. Some possible risks and side effects include:

– Lead migration or dislodgment which may need repositioning

– Infection at incision sites (low risk if <2%)

– Battery depletion requiring replacement every 5-7 years

– Nerve damage or increased pain (very low risk)

– Device malfunction necessitating repair or replacement

– Failing to get satisfactory symptom control during trial period

With proper patient screening, use of the trial phase, and close monitoring sacral nerve stimulation can be a low-risk treatment. Most side effects tend to be minor, and serious complications are uncommon with this minimally invasive approach.

Overall Results and Expectations

According to clinical trials and long-term follow-up studies:

– Approximately 60-80% of patients see a 50% or greater reduction in key symptoms during the trial phase

– About 50-70% maintain adequate relief of symptoms long-term if the permanent implant is successful

– Symptom control often plateaus within 3-6 months, though gradual improvement may still occur up to a year

– Programming adjustments can help if relief lessens over several years

– Reoperation risk is highest within the first year but decreases over time

– Quality of life benefits are reported by majority of individuals who experience sustained therapeutic effects

While SNS may not work for everyone, it represents an option worth consideration for appropriately selected patients. With proper patient counseling, screening, and regular follow-up care, it can potentially provide life-changing symptom relief in many cases.

1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it