What is sacral neuromodulation (InterStim)?

Device: The implantable device (size of a watch) is placed in the upper right buttock. It is connected to an implanted lead (wire) near the sacral nerves which regulate (modulate) the function of the pelvic nerves. The goal is normal function of the bladder and/or colon.

How it works: The implantable device sends mild electrical pulses to the sacral nerves, located near the tailbone. The sacral nerves control the bladder and colonic structures which result in urination and defecation. It is thought that abnormal activity of these nerves can result in urinary and or fecal incontinence. Sacral neuromodulation aims to help normalize the activity of the sacral nerves.

The procedure is completed in two stages

First stage procedures

The first stage (evaluation stage) consists of a test period to determine whether there is a positive response, for example, if urinary and/or fecal incontinence symptoms resolve or diminish to a great extent (our goal is at least a 50% improvement).

Procedure

• The device is implanted under anesthesia as an outpatient procedure lasting approximately an hour and a half
• Your child will have an internal lead (wire) placed near the sacral nerves in the lower back. The internal lead is then connected to an external temporary device that is conveniently and discreetly covered under clothing. The exit site of the lead will be covered by a dressing.
• Your child should feel a buzzing type sensation in their upper thigh or genital area when the device is on. This sensation should not be uncomfortable and will likely eventually be tuned out by your child.

Post procedure

During the evaluation period, which typically lasts two weeks, your child can continue to go to school or work but should avoid strenuous movement, lifting, bending or twisting. You will have access to a team of experts 24/7 to trouble shoot any problem that may arise.

• During this time, you and your child will use a symptom tracker to monitor urinary and/or bowel symptoms. Appropriate diaries and tools will be provided to you.
• If your child does not respond favorably during the evaluation period, he/she will have the internal lead removed under anesthesia and other treatment options will be considered.

Second stage procedures

In the second stage, if your child responds favorably during the evaluation period (50% or greater improvement in symptoms) they will undergo a second procedure under anesthesia to have the lead (wire) and device permanently implanted underneath the skin of the right upper buttock.

The device will not be felt when your child moves or sits down. The approximate battery life of the device is 10 years, after which time it will need to be replaced under anesthesia if symptoms still persist.

What are the risks and benefits of this therapy?

For many children who suffer from urinary and/or fecal incontinence, sacral neuromodulation therapy may eliminate or reduce symptoms when treatment with medications or behavioral therapy have failed.

This approach for bladder and/or fecal incontinence is reversible and can be discontinued at any time by turning the generator off. The device may be needed into adulthood. However, it does not need to be replaced as the child grows. Implanting the device has risks similar to any surgical procedure, including swelling, bruising, bleeding, and infection.
The device does not sound any alarms at airports and each child is provided with an identifying card. A medical alert wrist band is also available if you would like.

There are many skilled programs and individuals throughout the world that are familiar with this treatment and device should your family move to another location. Follow up care is easily available.

Watch a short informational video about InterStim® therapy