The Critical Role of Surgeon Expertise in Sacral Neuromodulation for Incontinence

Posted on: 21st Jul, 2023


Sacral neuromodulation (SNM) has emerged as a groundbreaking therapeutic modality for managing pelvic floor dysfunctions, specifically urinary and fecal incontinence. This innovative treatment—which begins with placement of a tiny pacemaker device under the skin in a 20-minute outpatient procedure—involves the modulation of sacral nerves, leading to improved control over bladder and bowel function. But it’s not just the procedure itself that creates the best outcomes. It’s the skill of the surgeon, along with five key considerations.

Patient Assessment

True experts in neuromodulation possess in-depth knowledge of the underlying pathophysiology of incontinence and understand the multifactorial nature of this condition. They can accurately diagnose the type and severity of incontinence, appreciate associated conditions like evacuation disorders of the rectum, urinary retention, and overactive bladder, identify any underlying anatomical or physiological abnormalities, and assess a person’s overall health status. It’s a comprehensive assessment that allows experts to determine exactly how well SNM may deliver improved pelvic floor function and predict the likelihood of success.

Customized Treatment Planning

Sacral neuromodulation requires precise electrode placement and programming to effectively modulate the sacral nerves. Experts in the field have a deep understanding of the anatomical nuances and functional intricacies of the sacral nerve pathways. They can create personalized treatment plans tailored to each patient’s unique anatomy, symptomatology, and goals. Expertise in placing the neuromodulation leads simply can’t be overemphasized. No two people exhibit the exact same neuroanatomy, especially in the sacral plexus area, where the nerves have typically fanned out like a horse’s tail, not like a single wire. 

Technical Proficiency

The successful implementation of sacral neuromodulation relies on the proper implantation of the device and accurate programming of the electrical parameters. Expert knowledge of surgical techniques, including the placement of the lead and neurostimulator, is the key to maximizing therapeutic efficacy. Skilled experts are adept at positioning the leads, selecting the appropriate implantable pulse generator and determining optimal stimulation parameters such as amplitude, frequency, and pulse width, ensuring effective neuromodulation while minimizing adverse effects.

Ongoing Management and Troubleshooting

Post-implantation care and long-term management are integral components of sacral neuromodulation. Usually this requires a team that includes the implanting surgeon and trained sacral neuromodulation programming experts who work for the device company. True expert teams possess the expertise to monitor patient progress, fine-tune stimulation parameters, and address any complications or adverse effects that may arise. They are experienced in troubleshooting issues related to device malfunction, lead migration, or battery life, and can provide timely interventions to optimize treatment outcomes. Expertise in interpreting patient feedback and integrating it with objective clinical data allows for continuous refinement of therapy, resulting in improved symptom control and patient satisfaction. In a few cases, replacing a lead or a device may result in big improvements in the bowel and bladder control.

Continuous Advancements and Innovation

The field of neuromodulation is rapidly evolving, with ongoing advancements in technology and treatment approaches. A final sign of expertise is a team that actively engages in research and stays current on the latest scientific literature. Here at The Continence Center of Nevada Surgical, we have been fortunate to contribute to latest scientific advances, publishing a paper in 2023 on the successful use of SNM for patients with multiple sclerosis. That makes our team well-versed in emerging techniques, such as non-rechargeable systems and novel electrode designs, which have the potential to further enhance the efficacy of sacral neuromodulation. Their expertise means we can our offer patients the most cutting-edge and evidence-based treatments available.

The Bottom Line

Sacral neuromodulation is already delivering tremendous results for people in the management of incontinence and overactive bladder, providing patients with improved quality of life and long-term symptom control. But this is only true when the procedure itself is done properly. Through comprehensive patient assessment, customized treatment planning, technical proficiency, ongoing management, and continuous pursuit of advancements, experts in sacral neuromodulation can maximize the therapeutic outcomes for patients with incontinence—just like we do here at Nevada Surgical.

Ready to learn more? Contact our team today for more information about this revolutionary approach to incontinence treatment.

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