Sacral Neuromodulation: A Chip to Regain Control of Your Bladder

Urinary incontinence, urinary retention, overactive bladder, pelvic floor dysfunction, bladder dysfunction without obstruction, but also fecal incontinence. These are some of the most common indications for sacral neuromodulation, a simple procedure, experts assure, but which requires a well-trained and prepared multidisciplinary context in the field. Like that of the Urology Operating Unit of the Policlinico of Bari (among the structures of excellence for urology ) led by Pasquale Ditonno , where on average about fifty implants are performed per year. For decades.

Sacral Neuromodulation is not for everyone

“Sacral neuromodulation involves the implantation of a pacemaker to correct the malfunction of the nerve centers of the sacral area, which controls the pelvic organs, such as the bladder and rectum,” Ditonno explains to Salute . “It is a well-established technology, but it is modern and not very widespread at a national level, so a multidisciplinary approach is required that involves, in addition to urologists and possibly proctologists, also physiatrists and neurological specialists. Functional studies and an extensive anamnesis are necessary to identify the patients who can benefit most, because sacral neuromodulation can be effective, but much depends on the patient's clinical conditions.” Sacral neuromodulation, in fact, is not a so-called first-line intervention for the indicated indications: it is attempted after the failure of more traditional therapeutic strategies, such as pharmacological ones and pelvic floor rehabilitation. And it is not a given that, despite the expertise of the teams that select patients, the intervention will always prove adequate.

How Sacral Neuromodulation Works

Regardless of the indications, neuromodulation is not an intervention suitable for everyone, adds urologist Gaetano de Rienzo of the Policlinico di Bari. And the numbers prove it: if there are about fifty pacemakers implanted under the skin at the level of the gluteus, almost double the number of tests carried out. "Before proceeding with the definitive implant, it is necessary to understand if the solution can be indicated for that patient - explains de Rienzo - and to do so, candidate patients are implanted at the level of the sacral foramen with an electrode connected to a miniaturized external stimulator, as big as an iPod".

This temporary device remains in action for about ten days, the urologist continues, during which the therapeutic effect is tested: "The results must convince both the patient, who must be able to have a net gain in terms of quality of life, and the clinician, who must be able to observe the improvements sought. When both are satisfied, then we proceed with the implantation of the electrode connected to the definitive pacemaker. Today, neuromodulators are also compatible with magnetic resonance imaging and this is particularly important for neurological patients who may need a sacral neuromodulation implant, such as those with Parkinson's or multiple sclerosis." It is a device just as big as a pen drive, which can remain in operation for several years. "When the technology works, the patient is well for many years: we have cases in which the pacemaker has remained in operation for over twenty years." The health system also benefits, saving on the use of diapers.

Factors that influence the success of the intervention

Sacral neuromodulation, experts recall, is a possible option for many patients with different diseases, but a fundamental criterion for access is represented by the presence of good coordination between bladder and sphincter. The success or failure of the implant depends instead on many factors, known only in part, conclude de Rienzo and Ditonno, such as the evolution of the underlying pathology and the time passed since the onset of the problem.