Sacral Nerve Stimulation for Overactive Bladder: Advantages and Potential Risks

Understanding Sacral Nerve Stimulation

An overactive bladder (OAB) is characterized by an urgent and frequent need to urinate, often accompanied by involuntary urine leakage known as urinary incontinence.

Sacral nerve stimulation (SNS), also called sacral neuromodulation, is an innovative treatment that involves implanting a small electrode beneath the skin to electrically stimulate nerves controlling bladder function.

This electrical stimulation helps regulate nerve signals traveling between the bladder and spinal cord, reducing OAB symptoms and improving bladder control.

SNS is typically recommended when conventional treatments such as:

• lifestyle modifications and pelvic floor muscle exercises
• oral medications
• botulinum toxin (Botox) injections into the bladder

have not provided sufficient relief. Continue reading to discover how SNS can effectively manage OAB symptoms.

How Sacral Nerve Stimulation Benefits Overactive Bladder Patients

OAB affects approximately 12% of the population, with prevalence increasing with age.

Since receiving FDA approval in 1997, sacral nerve stimulation has treated over 300,000 individuals worldwide. It addresses conditions including:

• urinary incontinence
• urinary retention
• frequent urination
• fecal incontinence
• chronic constipation (approved in Canada and Europe)

The therapy modulates electrical signals between the brain and bladder by targeting sensory nerves, mainly the third sacral nerve root (S3), to inhibit overactive nerve impulses that cause bladder urgency.

Clinical studies, such as a 2014 trial involving 147 mostly female participants, demonstrated SNS's superiority over standard medical therapies, achieving a 76% success rate—defined as over 50% symptom improvement—compared to 49% in control groups after six months.

Key Benefits of Sacral Nerve Stimulation Implants

SNS offers a less invasive alternative to surgical procedures like augmentation cystoplasty, with benefits including:

• Reduction in involuntary urine leakage
• Decreased frequency of urination
• Increased bladder capacity
• Alleviation of urinary retention
• Enhanced overall quality of life

Additionally, SNS can aid individuals suffering from fecal incontinence by improving bowel control.

Risks and Considerations of Sacral Nerve Modulation

While generally safe, 30-40% of patients may experience complications within five years of implantation.

A 2022 comprehensive review found no reports of life-threatening or irreversible major complications as of May 2021.

Costs can be significant, with average expenses reaching approximately $35,680 over two years and $36,550 over five years, exceeding alternative treatments like Botox injections. Surgical revisions may be necessary to reposition the device or leads if discomfort or device migration occurs.

Potential complications include:

• Infections
• Electrical shocks
• Device malfunctions
• Postoperative bruising (hematoma)
• Loss of therapeutic benefit over time

The Implantation Process: Evaluation and Surgery

The procedure involves implanting a small neurostimulator device, similar to a pacemaker, under the skin with leads connected to sacral nerves near the bladder.

Evaluation Phase

Before permanent implantation, a temporary device is used to assess effectiveness. A wire is inserted near the tailbone and attached to an external battery-operated stimulator worn on a belt. This trial typically lasts 2-3 weeks.

Research indicates that 62% of patients report symptom improvement after this evaluation, with some experiencing enhanced results following device reprogramming.

Implantation Phase

If the trial demonstrates at least a 50% symptom improvement, permanent implantation is offered. The device is placed beneath the skin in the upper buttock, connected to the sacral nerves. If the trial is unsuccessful, the temporary leads are removed or the evaluation may be repeated.

Who is an Ideal Candidate for Sacral Nerve Stimulation?

SNS is considered for individuals who have not responded to conservative treatments such as behavioral therapy, pelvic exercises, biofeedback, or medications including anticholinergics and beta-3 agonists.

However, certain patients may not be suitable candidates, including those with:

• Urinary tract obstructions
• Active pelvic infections
• Severe or rapidly progressing neurological disorders
• Multiple chronic health conditions, especially over age 55
• Poor response during the evaluation phase
• Need for MRI scans, although MRI-compatible devices are emerging

The safety of SNS during pregnancy remains uncertain.

Insurance Coverage

Many insurance providers, including Medicare plans like Blue Cross North Carolina, cover sacral nerve stimulation for urinary urge incontinence when patients meet specific criteria such as demonstrating a 50% symptom improvement during the trial phase.

Summary

Sacral nerve stimulation offers a promising treatment for overactive bladder by modulating nerve signals between the brain and bladder through a minimally invasive implant.

It is an effective option for patients who have exhausted conservative therapies, with a preliminary trial phase to assess individual response prior to permanent implantation.

Consult your healthcare provider to determine if sacral nerve stimulation is appropriate for your condition.

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