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Sacral nerve neuromodulation is accepted technology for patients with refractory urge incontinence, urinary frequency syndrome, and chronic urinary retention. This treatment consists of an implantable lead and neurostimulator (battery) using light electrical pulses to stimulate the sacral nerve controlling the bladder and other muscles that control urinary function. This article reviews the indications for neuromodulation as well as patient selection and testing phases associated with this technology.
Key Words: Interstim, urgency, frequency, incontinence, retention, stage 1, stage 2, percutaneous testing.
In 1988, Tanagho and Schmidt introduced sacral neuromodulation for management of the neurogenic bladder. Shafik (1999) subsequently demonstrated that electrical stimulation of the external urethral sphincter can inhibit detrusor contraction. These studies, in conjunction with the InterStim® device developed by Medtronic, Inc. (Minneapolis, MN), eventually led to the U.S. Food and Drug Administration (FDA) approval for use of the InterStim in treating refractory urge incontinence, chronic urinary retention, and urgency/frequency. The device has since been continually updated in response to technological advancement and clinical studies, resulting in improved treatment outcomes. In 2002, Medtronic released an implantable tined lead, making the procedure minimally invasive. In 2006, improved technology allowed the release of a smaller neurostimulator and improved patient programmer.
Since sacral neuromodulation for treatment of urinary dysfunction has become widely accepted, it is important that health care providers understand the technology. Nurses and/or other health care providers in the U.S. are likely to encounter a patient with an InterStim (sacral nerve neuromodulation). When providing care, it is important that nurses understand the implanted device (neurostimulator/battery), have some understanding of how the system works, and be aware of contraindications with this therapy.
MICTURITION
The central nervous system (CNS) works to control micturition; the CNS can treat a seemingly wide range of lower urinary tract dysfunctions (Leng & Morrisroe, 2006). Urinary voiding dysfunction has been broadly classified as a problem of storage or emptying (Latini, Alipour, & Kreder, 2005). Normal storage relies on the inhibitory input to the bladder supplied by the sympathetic neurons originating in the thoracic/lumbar spinal segments and the excitatory input to the bladder outlet (Comiter, 2005). Together these efferent pathways contribute to normal storage. The afferent pathways control the sensation of bladder fullness, the need to void, sensation of bladder pain, and perineal...