Name of the Procedure:

Sacral nerve stimulation test lead, each
Common name(s): Sacral nerve stimulation, Sacral neuromodulation
Technical/medical term: A4290 Sacral Nerve Stimulation Test Lead

Summary

Sacral nerve stimulation involves placing a test lead near the sacral nerve to determine if electrical impulses can help control bladder and bowel function. It’s a minimally invasive procedure used mainly to assess whether permanent implantation of a sacral nerve stimulator will be effective.

Purpose

Sacral nerve stimulation is designed to address urinary incontinence, overactive bladder, and fecal incontinence. The goal is to improve quality of life by reducing symptoms of these conditions, which don't respond well to other treatments.

Indications

• Symptoms of urinary incontinence or difficulty in bladder control
• Overactive bladder with frequent urination and urgency
• Fecal incontinence, or inability to control bowel movements
• Patients who have not had success with or are not candidates for other treatments

Preparation

• Patients may need to undergo a bladder diary or other urodynamic studies.
• Fasting may be required for a specific period before the procedure.
• Adjustments to current medications might be necessary under doctor’s guidance.
• Pre-procedure consultation to discuss medical history and allergies.

Procedure Description

1. Preparation: The area around the lower back is cleaned and sterilized.
2. Anesthesia: Typically, local anesthesia is administered.
3. Placement: Using fluoroscopy (live X-ray), a fine needle is inserted into the sacral foramen.
4. Lead Insertion: A test lead (thin wire) is placed near the sacral nerve.
5. Testing: Electrical impulses are sent to test nerve response and symptom relief.
6. Temporary External Device: The lead is connected to an external stimulator for a trial period, usually a few days.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in an outpatient clinic or surgical center.

Personnel

• An experienced urologist or colorectal surgeon
• Nurses and possibly a medical technician
• An anesthesiologist or nurse anesthetist for local anesthesia

Risks and Complications

• Risk of infection at the insertion site
• Bleeding or bruising
• Pain at the lead insertion site
• Allergic reaction to materials used
• Nerve irritation or damage, though rare
• Possible failure to achieve symptom relief

Benefits

• Symptom reduction or elimination of urinary and fecal incontinence
• Improved bladder control and reduced urgency and frequency
• Enhanced quality of life when other therapies have failed
• Benefits may be realized within the trial period itself

Recovery

• Patients are usually observed briefly and then can go home.
• Instructions on how to care for the insertion site will be provided.
• Patients should avoid strenuous activities and heavy lifting for a few days.
• Follow-up appointments for assessment of symptom relief and potential permanent implantation are necessary.

Alternatives

• Behavioral therapies (e.g., pelvic floor exercises, bladder training)
• Medications to control symptoms
• Surgical options like bladder augmentation or urinary diversion
• Comparative pros: Sacral nerve stimulation is less invasive and reversible.

Patient Experience

• During the procedure, patients may feel minor discomfort from needle insertion and electrical impulses.
• Post-procedure, patients may experience mild pain or soreness at the insertion site.
• Pain management options include over-the-counter pain relievers and physician-recommended methods.
• Overall, the procedure is well-tolerated and offers significant potential benefits with minimal discomfort.