Sacral neuromodulation, which is also called interstim, acts to provide a small amount of electrical stimulation to the nerves that run through the tailbone (sacrum) to the bladder. For reasons we do not well understand, this can improve or eliminate bladder overactivity and urinary leakage. Another application of this therapy is for patients that develop urinary retention and cannot urinate effectively. This therapy can be thought of as a bladder pacemaker. The electrical stimulation is usually not something that causes pain or discomfort.
University of Utah Health Care urologic specialists are experts in sacral neuromodulation. Call today to schedule a consultation and find out if interstim therapy is right for you.
Who does this therapy work for?
One of the best applications of this therapy is for women that have overactive bladder. In this condition with aging the bladder starts to give inappropriate signals to urinate and patients feel urgency and frequency of urination.
This is a condition that affects mostly aging women. When this condition is severe women will frequently have urinary leakage as a result of the bladder spasms. Another application of the therapy is in women that have a condition where their bladder stops working. This is referred to as Fowler’s syndrome. Often there is some precipitating factor like a recent unrelated surgery.
What are other applications of sacral neuromodulation?
There are some other conditions that can respond to the use of sacral neuromodulation:
Spinal Cord Injury: One of these conditions is found in patients with partial spinal cord injury. Usually a good measure of partial spinal cord injury, which might respond to sacral neuromodulation is a patient with greater than 50 percent motor function below their injury. For instance some patients can walk after a partial spinal cord injury. These patients may respond to sacral neuromodulation and eliminate bladder spasticity or urinary retention.
Multiple Sclerosis: Another potential application is patients with multiple sclerosis that have good lower extremity function and can walk well. In a similar way to partial spinal cord injured patients, the fact that these patients are ambulatory indicates that many of the spinal pathways that are needed for this therapy to work are intact.
How is sacral neuromodulation performed?
Sacral neuromodulation is an outpatient procedure that involves two operations about one to two weeks apart.
Operation 1: In the first operation patients are in a twilight sleep with anesthetics and lie on their stomachs in the operating room. The locations of the nerves to the bladder are found and electrodes are placed onto the nerve on both sides. The electrodes are internally connected to temporary small wires that come out of the side of the body.
When the patient wakes up a temporary stimulator is connected to these wires. The patient then has the nerves stimulated for one to two weeks from this external unit. If the patient’s urinary problem is improved by 50 percent or resolved with the therapy than the permanent unit is placed.
Operation 2: In this second operation the permanent electrodes placed in the first operation are attached to a stimulator that is implanted above the buttock and hipbone. This unit will last three to seven years depending upon several factors, like how much stimulation is required. It can be changed, in the future, when the battery wears out in a small surgery without disturbing the permanent electrode in the nerve.
If the first surgery and the stimulation is not successful than in the second operation the electrodes are removed.
William O. Brant, MD FACS FECSM, is a board-certified urologist, specializing in sexual dysfunction, disorders of the penis, Men's Health, Peyronie's disease, male urinary incontinence, scrotal and testicular problems, and prosthetic surgery. He attended Dartmouth College (undergraduate) and the University of Washington, Seattle (graduate) and then... Read More
Dr. Hotaling has significant training in both the clinical aspects of male fertility and genetic epidemiology and he is currently the only fellowship trained male infertility/andrology expert in Utah. He completed a 6 year residency in urology at the University of Washington, elected to pursue a year of sub-specialty training in male infertility ... Read More
Richard is a board certified Physician Assistant. His clinical emphases include men’s health and general urology as well as clinic procedures for hypogonadism, erectile dysfunction, incontinence and Peyronie’s Disease. He works closely with the physicians of the Men’s Health Clinic, including pre-operative and postoperative care. He is a member of ... Read More
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Dr. Lenherr is a urologist who focuses on treatment of female incontinence and management of bladder dysfunction. She received her medical degree from the University of Chicago and completed a 6-year residency in urology at the Lahey Clinic outside of Boston. She then elected to pursue two years of sub-specialty clinical training in female pelvic m... Read More
Bladder Augmentation, Chronic Urinary Tract Infections, Complications of Spinal Cord Injury, Complications of Urologic Surgery, Female Incontinence, Incontinence, Mesh Erosion, Neurogenic Bladder, Pelvic Dysfunction/Incontinence, Trauma and Reconstructive Urology, Urology, Vesicovaginal Fistula
Dr. Myers completed specialty training with Dr. Jack McAninch at University of California, San Fransisco. His fellowship was in trauma and urologic reconstructive surgery. In his practice, Dr. Myers treats a variety of conditions. These include conditions like urethral strictures, ureteral scarring from previous surgery or congenital development... Read More
Bladder Augmentation, Complications of Spinal Cord Injury, Complications of Urologic Surgery, Female Incontinence, General Urology, Mesh Erosion, Neurogenic Bladder, Pelvic Fractures and Urethral Injury, Radiation Injuries, Trauma and Reconstructive Urology, Ureteral Stricture, Urethral Stricture, Urinary Diversion, Urinary Strictures and Fistula, Urology, Vesicovaginal Fistula
Kelley is a board-certified adult-gerontology acute care nurse practitioner (AG-ACNP). She has been with the University of Utah Department of Urology since 2014. Prior to this, her educational emphasis was adult urology. Clinical emphases include men’s health and male infertility as well as clinic procedures for hypogonadism, erectile dysfunction, ... Read More