Sacral nerve stimulation
Sacral nerve stimulation delivered by InterStim™ therapy is now MBS Listed for adults with detrusor overactivity.
... and non-obstructive urinary retention refractory to conservative, non-surgical intervention.
The widespread funding of the therapy, which has been available for selected patients for more than a
decade, is welcomed by Australian patients who see the listing as long overdue given the proportion of
Australians experiencing continence issues without appropriate relief. Incontinence affects approximately
4 million Australians in some form and remains a largely under-reported condition.
“Even the World Health Organization (WHO) recognises continence issues are not a natural part of
ageing,i yet a large amount of incontinence is unmanaged due largely to patient embarrassment,
ignorance or willingness to admit the condition,” said Dr Ian Tucker, Urogynaecologist and Vice
President of the Continence Foundation of Australia (CFA). “It has required an ongoing commitment to
finally ensure local availability of a treatment which we hope will go some way to addressing the negative
quality of life and mental health impacts that often go hand in hand with poorly managed continence.”
InterStim™ therapy treats urinary retention and the symptoms of overactive bladder, including urinary
urge incontinence and significant symptoms of urgency-frequency – the inability to hold urine long
enough to reach a restroom.
The CFA estimates 65 per cent of women and 30 per cent of men sitting in a GP waiting room report
some type of urinary incontinence, yet less than one-third of these people report having sought help from
a health professional.
With this in mind, Dr Tucker believes general practitioners are ideally placed within the Australian health
system to provide and coordinate care for persons affected by incontinence, including referral for SNS,
after more conservative treatments have failed.
“While much urinary incontinence is managed successfully within general practice, it is important that
patients who have failed first-line options including lifestyle modifications and other treatments such as
medications, kegel exercises, and physical therapy, or who experience intolerable side effects from
pharmacotherapy, are referred for consideration of SNS,” he said.
“The test phase allows patients to experience therapy for 7 to 14 days and is performed by a Urologist or
Urogynaecologist sometimes as a day procedure. It requires the specialist to insert a thin, flexible wire
near the third sacral nerve. This electrode is then connected to an external stimulator. It effectively
allows patients to experience the benefits of the therapy first-hand, prior to making a commitment to
insertion of the pulse generator [pacemaker] for long term InterStim therapy.”
Neurostimulation is a reversible treatment option that can be discontinued at any time by turning off or
removing the device. Many people with neurostimulation have reported significant improvements to
quality of life.ii
Replacement or removal of the pulse generator and/or leads for the neurostimulator device is also now
MBS Listed.
About sacral nerve stimulation
Used to treat more than 55,000 patients worldwide who have failed more conservative bladder control
treatments, SNS uses a small, implanted device to send mild electrical pulses to the sacral nerves.
Located near the tailbone, the sacral nerves influence the bowel and surrounding muscles that manage
bowel function. If the brain and sacral nerves don’t communicate correctly, the nerves can’t interact with
the bladder to function properly, leading to symptoms of urinary retention. Stimulating the sacral nerves
helps the brain and nerves communicate so the bladder can function properly.
About urinary incontinence
The Continence Foundation of Australia has found that almost 37 per cent of Australian women, and 13
per cent of Australian men, have been affected by urinary incontinence:iii
• Urinary incontinence among males increases with age with up to 40 per cent of men over the age
of 85 reporting some level of urinary incontinence.
• The prevalence of urge incontinence, which is strongly associated with prostate disease, is fairly
low in younger males and increases to 30 per cent for those aged 70-84 and 50 per cent for
those 85 years and over.
• Women comprise over 70 per cent of people affected by incontinence, with problems arising
primarily after childbirth and menopause.
Causes include:
• Other health conditions and diseases -
such as prostate disease.
• Body mass index and obesity.
• Pregnancy, childbirth and menopause.
• Lower urinary tract symptoms.
• Constipation.
• Surgery (for example, surgery for prostate
cancer).
• Mobility and cognitive impairment.
Risk factors include:
• Pregnant, pre- and post-natal women
• Younger women who have had children
• Women who are overweight
• Menopause;
• Obesity;
• Urinary tract infections;
• Constipation;
• Specific types of surgery such as
prostatectomy's and hysterectomy's;
• Reduced mobility;
• Neurological and musculoskeletal
conditions such as multiple sclerosis and
arthritis;
• People with health conditions such as
diabetes, stroke, heart conditions,
respiratory conditions, and prostate
problems and
• Some medications
Symptoms include:
• Leak urine with coughs, sneezes,
exercise or on the way to the toilet.
• Pass urine frequently.
• Rush to the toilet - urgency.
• Get up twice or more at night to pass
urine.
• Wet the bed when asleep.
• Feel their bladder is not completely empty.
• Poor urine flow.
• Strain to get the bladder to empty.
• Frequent urinary tract infections.
Early intervention may prevent or delay problems recurring or getting worse later in life,
such as:
• Drinking between 1.5-2 litres of fluid every day, the majority of which should be water. Note: the
normal urine output is 1.5 litres/24hrs and should not exceed 2 litres/24hrs.
• Limiting caffeine and alcohol intake.
• Maintaining good bladder habits by only going to the toilet when the bladder is full.
• Learning how and when to perform pelvic floor muscle exercises.
• Treating the cause of any chronic coughing or sneezing (for example, asthma or hayfever).
• Maintaining a healthy weight.
• Avoiding smoking.
i World Health Organization Calls First International Consultation on Incontinence. Press Release WHO/49, 1 July 1998.
http://www.who.int/inf-pr-1998/en/pr98-49.html (Accessed 12.10.2006)
ii Brazzelli M, Murray A, Fraser C, Grant A. Systematic review of the efficacy and safety of sacral nerve stimulation for urinary urge
incontinence and urgency-frequency. Aberdeen: Review Body for Interventional Procedures; 2003. Commissioned by the National
Institute for Clinical Excellence.
iii Continence Foundation - About Incontinence - Facts and Stats http://www.continence.org.au/site/index.cfm?display=112756