Pre-operative Preparation for a Sacral Nerve Stimulation procedure
The procedure to insert temporary SNS leads is usually done under sedation and local anaesthesia, whilst the placement of the permanent leads and the neuro stimulator are performed under general anaesthesia. The pre-operative preparation is the same for both namely you are able to eat up to 6 hours prior to your procedure and drink water only up to 2 hours prior to your procedure.
Placement of temporary SNS leads
The objective of this procedure is to place a fine electrode through the skin over the lower part of the spinal column (the sacrum). It is then passed through the S3 foramen on one or both sides just deep enough for it to stimulate the S3 nerve (the nerve that controls the anal sphincter complex). The electrode is then attached to a temporary stimulator which the patient wears on a belt for approximately two weeks to assess its efficacy. A clear plastic dressing is placed over the wire.
It is important that the temporary stimulator is kept dry at all times. Certainly the patient can shower but the stimulator has to be kept clear of the water.
Post-operatively the patient goes home the same day. There is very little in the way of discomfort. Paracetamol is a perfectly acceptable form of analgesia and can be taken as required.
Placement of permanent SNS leads and insertion of neuro stimulator
This procedure is performed under general anaesthesia. The objective of this procedure is to place a fine electrode through the skin over the lower part of the spinal column (the sacrum). It is then passed through the S3 foramen on one or both sides just deep enough for it to stimulate the S3 nerve (the nerve that controls the anal sphincter complex). A separate incision is made over the fat pad just lateral to the sacrum. The leads are connected to the neuro stimulator and the latter is then buried beneath the subcutaneous fat. This stays in place indefinitely, although from a practical perspective the batteries need to be replaced every seven to eight years. The neuro stimulator is approximately the size of a matchbox and it is a very simple matter to reopen the original incision, extract the neuro stimulator, replace the batteries and place it through the same incision.
Post-operatively patients go home the same day.
Post-operative Care following a Sacral Nerve Stimulation procedure
Following your procedure there are a number of things of which you need to be aware.
A certain level of discomfort can be expected. However this is usually fairly mild and can be adequately controlled with simple analgesia such as paracetamol. You will be discharged home with some Panadeine Forte or Endone and this only needs to be taken if the paracetamol fails to control your pain.
There will be a dressing over the wound which can be left in place for a week. This is waterproof and you can get in the shower. Simply dab dry with a towel. If it hasn’t fallen off in a week it can be safely removed at this point. If it falls off prematurely, the wound can simply be left open to the fresh air. At that point the wound can be washed with soap and water and once again simply dab dry with a towel.
Physical Activity (including sexual activity)
It is very important to maintain a degree of physical activity following your operation. Please feel free to move around the house and go for short walks starting in the immediate post-operative period. The degree of physical activity that is permissible is largely common sense. Too much will simply increase your discomfort level. As a general rule you should slow down if the wounds or the operation site becomes uncomfortable and build up gradually each day. Certainly within a week to 10 days you should be able to pursue normal day to day activities, with the exception of lifting heavy objects - this should be avoided for a period of 4 weeks following the surgery. Resuming sexual activity is once again a matter of common sense - it should be introduced on a gradual basis.
The patient is seem by the Medtronic technician before and after the procedure. Dr Renaut will see you for a routine follow up visit in approximately four weeks. If there are perceived problems with the neuro stimulator at any time before this or after your follow up visit then contact his office and you will be put in touch with the Medtronic technician.