Information about your operation: Sacral nerve stimulation (SNS) Urogynaecology Unit Information for Patients i Important supplementary information
What is an overactive bladder? Women with an overactive bladder (OAB) have: Urgency this is a very sudden and strong feeling of needing to pass urine which is difficult to control To pass urine frequently during the day and/or night Urge leakage of urine leakage of urine as you are trying to get to the toilet These symptoms are caused by the bladder muscle trying to push urine out even when it is not yet full. OAB symptoms are common and affect about 2 in 10 women. In most cases, no cause is found. Treatments for OAB Bladder retraining. Our nurses can help you to retrain your bladder so that it works more normally. Part of bladder retraining also involves drinking the correct amounts and the right types of fluid. Medication. Anticholinergic medication relax the bladder muscle and prevent unwanted bladder contractions. These tablets may cause a dry mouth and constipation. BOTOX bladder injections. These injections are reserved for women in whom bladder retraining and medications have not helped. These injections work by relaxing the muscle of the bladder. They are effective at reducing OAB symptoms in about 7 in 10 cases. The injections wear off with time and repeat injections are needed every 6-12 months. Sometimes, the injections relax the bladder muscle too much and you are not able to empty your bladder. This may occur in 1 in 15 cases. If this happens, you will need to insert a catheter (bladder tube) a few times a day to empty the bladder (self-catheterisation). Sacral nerve stimulation (SNS). This treatment is reserved for women in whom bladder retraining and medication have not helped. SNS changes how the sacral nerves work using mild electrical pulses. The sacral nerves control how your bladder works. These nerves are in your lower back near the tailbone. SNS improves overactive bladder symptoms in up to 80% of patients. 2
SNS procedure SNS procedure The treatment is carried out in 2 stages. In the 1 st stage, a temporary stimulator is inserted in your lower back. This is carried out using local anaesthetic and sedation (you will be awake but very sleepy). It takes about 45 minutes and only involves needle pricks in your back. The temporary stimulator is a long thin wire. One end is inserted through the skin and is placed close to the nerves in the lower back. The other end is attached to a small device which controls the electrical impulses. You will be taught how to use this device the day after your surgery. When switched on, you may feel a tingling, tapping, dragging or pulling sensation anywhere from your urine pipe to your back pas sage. You and your doctor will see how well the temporary stimulator works over the next 2 4 weeks. If it helps significantly with your bladder problem, a permanent stimulator (2 nd stage) will be a good option for you. The 2 nd stage involves inserting a permanent stimulator. It is a day case procedure and is carried out under local anaesthetic and sedation. A few small cuts in your lower back are made and a permanent wire is inserted under your skin. A small battery device which gives off the electrical impulses is also placed under your skin. You will not be able to see the wire or battery at all. The battery is controlled using a remote control which you will be taught how to use. The battery lasts for 5 10 years and needs to be replaced. 3
Risks What are the risks? You may have pain where the wire and battery have been inserted. The wire and battery can get infected. There may be technical problems causing the device not to work well. The electrical impulses may worsen your bladder or bowel function. The electrical impulses may cause uncomfortable or painful sensations. Approximately a third of patients might need further surgery because of problems with the device. Sometimes the device may need to be removed. What kind of precautions will I need to take in the future? Always inform your doctors that you have a sacral neuro modulator if you are having any kind of surgery or x-ray investigation (e.g. MRI, CT, ultrasound). Show them your SNS identification card. At the airport it is advisable to avoid (if possible) going through the metal detector. Show the security your SNS identification card. If you do have to pass through a metal detector, it is essential you turn your SNS off. Follow up Specialist SNS nurse will be in touch with you within a week of the procedure. She is also your first point of contact if the need arises. 4
Contact information Contact information: Urogynaecology Secretary LRI 0116 2586426 Urogynaecology Secretary LGH 0116 2584861 Ward 31 LGH 0116 2584843 5
If you have any questions, write them down here to remind you what to ask when you speak to your nurse/consultant. 6
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Leaflet Produced: March 2017 Next Review: March 2019 (Bowden) - Urogynaecology - WPS118-0317 Today s research is tomorrow s care We all benefit from research. Leicester s Hospitals is a research active Trust so you may find that research is happening when you visit the hospital or your clinic. If you are interested in finding out how you can become involved in a clinical trial or to find out more about taking part in research, please speak to your clinician or GP. If you would like this information in another language or format, please contact the service equality manager on 0116 250 2959