Sacral Neuromodulation

What is sacral neuromodulation?

A thin lead is placed near the third sacral nerve root and connected to a small generator implanted under the skin of the upper buttock. Mild electrical pulses normalize communication between the bladder, the pelvic floor, and the brain.

Who may benefit?

• Patients with overactive bladder unresponsive to medication.
• Patients with non-obstructive urinary retention or incomplete emptying.
• Patients who prefer not to have repeat Botox injections.
• Patients with coexisting fecal incontinence.

How is the procedure performed?

Therapy is staged. First a test phase places the lead and connects it to an external generator for one to two weeks so you can measure the benefit in daily life. If your symptoms improve substantially, a second short procedure implants the permanent generator.

What are the benefits?

• You try the therapy before committing to a permanent implant.
• Treats both urgency symptoms and retention.
• Adjustable and fully reversible.
• Current devices are rechargeable, MRI conditional, and long-lasting.

What are the alternatives?

Behavioral therapy, medications, bladder Botox, tibial nerve stimulation, and intermittent catheterization for retention.

What are the risks?

• Pain or discomfort at the implant site.
• Infection, which may require device removal.
• Lead migration or loss of effect requiring reprogramming or revision.
• Unpleasant stimulation sensation, usually corrected with programming.

What should I expect before surgery?

• A pre-operative visit to review your history, medications, and goals.
• Instructions on blood thinners, supplements, and diabetes medications.
• A urine culture so any infection is treated before the procedure.
• Nothing to eat or drink after midnight unless told otherwise.
• A responsible adult to drive you home on the day of surgery.

What should I expect during recovery?

• You keep a bladder diary during the test phase to measure real improvement.
• Avoid bending, twisting, and lifting for several weeks after implant.
• Programming is fine-tuned at follow-up visits.

When should I call the office?

• Fever above 101.5°F or shaking chills.
• Inability to urinate, or a catheter that stops draining.
• Heavy bleeding, or clots that do not clear with increased fluids.
• Pain that is not controlled by your prescribed medication.
• Redness, swelling, or drainage at an incision site.