Sacral nerve stimulation surgery

Faecal and urinary incontinence are common problems which have a major impact on patients’ quality of life. 20 to 25 per cent of affected individuals fail with conservative treatment. For many of these patients a permanent colostomy (link to colostomy) has been the only available option. Alternative surgical procedures such as sphincteroplasty, dynamic graciloplasty and artificial bowel sphincter implantation are also available for chronic faecal incontinence conditions, but have shown disappointing long-term results.

Sacral nerve stimulation (SNS) which is available at Intus – Digestive and Colorectal Care, also known as Sacral neuromodulation (SNM) is an effective treatment for appropriately selected patients with severe faecal or urinary incontinence who have been unresponsive to conservative treatment. More recently it has also demonstrated effective treatment for severe chronic constipation and intractable chronic anorectal and pelvic pain.

SNS has been used for nearly twenty years in more than 100,000 patients worldwide. SNS was released in Europe, Canada and Australia in 1994, received FDA approval in the US for urinary incontinence back in 1997 and received approval for treatment of faecal incontinence in Europe in 1994, in Australia in 2006 and in the US in 2011.

As a result of technical advances this therapy is now a simple, safe and minimally invasive technique.

The procedure comprises of a diagnostic stage (test trial stimulation) where an electrode is inserted via a minimally invasive procedure performed under general anaesthesia and stimulation is provided by an external pulse generator for a test period of usually 2-3 weeks to assess the therapeutic effects of SNS. Individuals who show a positive response (>50 per cent reduction in symptom episodes) will proceed to a permanent implantation of the SNS device. This involves a second procedure under general anaesthesia where a little battery, similar to a heart pacemaker, is placed in a subcutaneous pocket in the upper buttock. The expected battery life for a pulse generator is approximately 8 years. It can easily be replaced under local anaesthesia.

The implanted stimulator is programmed individually to suit the patient. The surgeon can adjust the settings using an external programming device. The patient can turn the stimulation on or off using a hand-held patient programmer. When necessary, the stimulation parameters are reprogrammed according to the patient's perception. Continuity of care may require that the device be reprogrammed, which is supported by our practice nurses.

SNS is performed by colorectal surgeons at Intus specifically trained in this procedure. Neurosurgeons may also perform this procedure.