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A. This procedure involves initially temporarily stimulating the nerves in the sacrum to see if stimulation alters bladder function. If the test is successful, the stimulating implant is inserted into the buttock area and connected to the stimulating electrode.
A. The alternatives include:
A. If you are taking blood thinning medication on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. Aspirin does not usually need to be stopped but will be the decision of your surgeon.
You will usually be admitted on the same day as your surgery, or a day before. You will normally undergo pre assessment on the day of your clinic. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.
You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
Please be sure to inform your urologist in advance of your surgery if you have any of the following:
A. Currently, the procedure consists of two different admissions. During the first admission (the test phase), the permanent tined lead is placed into one of the sacral nerves in your lower back. The test electrode is connected to a device which generates electrical impulses for three to five days but sometimes up to two to four weeks. During this time, you will be at home and will be asked to complete an input/output chart. You will have a wireless hand controller that allows you turn the power of stimulation up or down or off.
You will then be reviewed to see if you have had improvement during this test phase. If you have not, you will need another short anaesthetic to remove the lead. If you have had a good response, you will need a second short general anaesthetic procedure to place the permanent stimulator (also known as the implantable pulse generator or IPG).
A. On the day of your surgery, your implant will be switched on and programmed so that you obtain maximum benefit with regard to your symptoms whilst ensuring maximum comfort for you. When the implant is switched on, you will feel a tapping sensation in the genital or rectal area.
We will teach you how to use the programmer.
The average hospital stay is 24 to 36 hours.
A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
Common (greater than one in 10)
Occasional (between 1 in 10 and 1 in 50)
Rare (less than 1 in 50)
A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.
If you have problems using your programmer, please contact your urologist.
A. If you experience any flu-like symptoms, redness/throbbing in the wound, pain/burning when passing urine or difficulty passing a catheter, please contact your urologist.
You may require repeated visits to Hospital to “fine tune” your programmer. Over time, the body can become conditioned (used) to the programmer settings and you may need advice on re-programming.
A. After you wake up, the test stimulator box will be attached. When the implant is switched on, you will feel a tapping sensation in the genital or rectal area. There are two dials on the top of the stimulator. One will be taped over as you do not need to change the settings on this. The other has numbers on it which you will be able to adjust. This level will be adjusted whilst you are awake.
You can either leave the stimulator at this level so that you can slightly feel it or set the stimulator just below this level so that you cannot feel it. This depends on what is more comfortable for you.
If you have it slightly below then turn the dial up slightly each morning to ensure that you can still feel it and the equipment is working.
Don’t forget the stimulator box is attached to you. If it pulls, it may dislodge the wire.
A. If on turning the stimulator up each day you cannot feel anything at the level previously set, try turning it up slightly more as sometimes over time this will alter. If despite doing this, you still cannot feel anything, turn the stimulator off and change the battery. Then go through the process again. If still nothing happens, contact the urologist.
A. When you move (especially bending/twisting), the wire may move slightly in relation to sacral nerves and the level of stimulation may change so you could feel a sudden increase or decrease in stimulation.
This is normal but could feel uncomfortable and give you a surprise and make you jerk suddenly.
For this reason do not drive or operate heavy machinery or dangerous equipment during the test period. If for any reason, you suffer any of the above, turn the stimulator off and on again.
A. The temporary wire is not stitched in place and is only held in place by the dressings covering the area. To avoid dislodging the lead: