- Reference Number: HEY-048/2019
- Departments: GI Physiology
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This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.
What is a Permanent Sacral Nerve Neuromodulation?
Neuromodulation is the use of low voltage electricity to make nerves work better.
You have probably been troubled by difficulty going to the toilet, faecal incontinence, constipation, urinary or pelvic floor disorders. Following a successful trial of temporary sacral nerve neuromodulation your doctor may have suggested that permanent sacral nerve neuromodulation may be a realistic treatment option for you.
The procedure involves implanting an electrode in your lower back while you are sedated or under a general anaesthetic. This electrode neuromodulates the sacral nerve which is involved in the function of the muscles around your anal canal, bladder and the pelvic floor. This electrode is connected via a wire to an internal neuromodulator which is placed in the upper buttock. You will be shown the neuromodulator at your clinic appointment.
Why do I need Permanent Sacral nerve Neuromodulation?
Permanent sacral nerve neuromodulation is offered to people who have faecal incontinence, constipation, urinary or pelvic floor disorders, often when other medical or surgical procedures have not worked. By neuromodulating the sacral nerve, the anal and pelvic floor function may be greatly improved and therefore improving symptoms. Patients who undergo this procedure are required to have had a successful outcome from the temporary sacral nerve neuromodulation procedure.
Can there be any complications or risks?
Like all surgery there are potential risks. Some of these risks relate to surgery and anaesthetics, whilst some risks are specific to this procedure.
The significant risks specific to this operation relate to the chance of nerve injury or bleeding within the pelvis due to insertion of the wires. This complication occurs in less than 1% of patients but may result in further surgery being required.
There is also a risk of the bowel being injured as the permanent wire is inserted; a repair may involve major abdominal surgery. The risk of this happening is less than 1%.
Some patients experience pelvic pain and leg pain when the neurostimulator is switched on. This can usually be overcome by altering the settings but occasionally the neurostimulator has to be removed. Similarly because we are neuromodulating the pelvic nerves you may find there are adverse effects on other pelvic function (passing urine and sexual function).
In the event that such a neuromodulation related event actually occurs, you can switch the neurostimulator off (using a small handheld device) which should reverse any side effects from electrical stimulation.
After the initial surgery, there is a long-term risk of the implant or wire malfunctioning. 18% of patients have required revision surgery, for example to replace the wire or reposition the implant. The power in the implant lasts for three to six years. When the power runs out, it will need replacing.
Once your neurostimulator has been implanted, you will not be able to have a Magnetic Resonance Imaging scan (MRI) due to having a metal implant, but all other medical tests are possible. Even if your implant is removed at a future date, there is a chance that the wire cannot be totally removed and therefore you would still not be able to have an MRI scan.
There is a chance that this procedure will not benefit you, despite having tested as suitable with a temporary sacral nerve neuromodulation.
While this is now a well-established and low risk operation, there may be other risks and side effects that we are as of yet unaware of.
How do I prepare for Permanent Sacral Nerve Neuromodulation?
Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this procedure.
As with all surgery, you will be asked to stop eating and drinking prior to the procedure. You will be informed when to do this either on your admission letter or at the time of your pre-assessment appointment.
What will happen?
You will be told either at your pre-assessment appointment or in your admission letter where you should report to and when.
Just before the procedure you will be taken to the operating theatre, where you will either be sedated or given a general anaesthetic (put to sleep). The procedure will last approximately 40 minutes. During this time your doctor will place the electrode into your back using a needle. The neurostimulator will then be placed under the skin in one of the buttocks and connected to the stimulating electrode through a small channel under the skin.
Once the neurostimulator is in place, you will then go to the recovery area and then to a ward. You will feel some discomfort from the area where the electrode and neurostimulator have been placed until the wound has healed.
An appointment will be arranged for you, usually two weeks following implant, when it will be switched on and when programming will start. You will then be able to go home.
What will happen afterwards?
Once you are discharged from hospital, you are advised to take things easy for a couple of weeks to allow the area where the neurostimulator was implanted to heal.
Avoid baths and full showers for the first two weeks in order for the wound to fully heal. Your dressing should be changed after a week. In normal circumstances, you should be able to return to normal activities after two to four weeks.
You will be asked to visit the Department of GI Physiology after two weeks, one month, three months, six months and then at yearly intervals to assess your neurostimulator and to see if it needs any minor modifications to its program settings.
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Department of GI Physiology (01482) 624036
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.