Stage 1 | Stage 2 | Post Operative Period | Work/Disability | Driving | Restrictions
You are going to be having an outpatient surgical procedure to help your urinary condition.
Our surgical schedulers will be scheduling you for two procedures and a follow up visit. The procedures will be approximately two weeks apart.
Stage 1
The first procedure (Stage 1) involves placing a small wire into the sacrum (lower back bone). The wire is placed under your skin in the buttock area and is then connected to another wire that comes out of the skin. This wire is connected to a battery pack that you wear on your belt. This wire device allows the nerves around the sacrum to be stimulated. These nerves ‘feed’ the bladder and can be ‘turned-up’ or ‘turned-down’. Thus, it allows us to better control the nerve signals to the bladder to either quiet the bladder down (in instances of overactive bladder conditions) or increase bladder function (in instances when the bladder is underactive).
You will be asked to perform a voiding diary when you leave the hospital, while the stimulation is on, and before your follow-up visit (which is one week after Stage 1). At this visit, a determination will be made to see if the stimulation has significantly improved your symptoms (urinary frequency, urgency, and leakage of urine, waking up at night (nocturia)). If there is a significant improvement, the second procedure will involve the placement of the pacemaker (IPG Stage 2).
Stage 2
Stage 2 occurs approximately 2 weeks later and is also performed as an outpatient procedure.
The pacemaker will be placed under the skin and the wire will be buried under the skin, so nothing will show outside your body. If there is not a significant improvement after the 1st week, then the wire will simply be removed.
During the procedures, you are given intravenous sedation and during certain parts you are asked where you feel the stimulation. This interaction is essential in helping achieve the best outcome and resolution of your symptoms. All procedures are same-day and do not involve an overnight hospital stay.
Positioning during the procedure involves lying on your stomach and positioning the bed to maximize the location of the sacrum (bone in the middle of your buttocks) to assist in the placement of the device. Adequate padding is provided and the operating room and anesthesia teams are experienced in assisting with your comfort during the procedure. Two separate incisions are made. You will have a 4-5 cm incision over your buttocks below your waist on either the right or left side and a 1 cm incision over your bone in the middle of your buttocks. The side is chosen by the best response during the procedure. Patients describe the stimulation they feel in the pelvic / genital area in a variety of ways. Examples include vibration, tingling, tapping, pulsing, pulling or a pressure sensation.
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Post Operative Period
A small amount of blood on the dressing is normal. Discomfort at the operative sites and generalized aches are normal for the first few days. Rest, take your pain medication, and use cold packs which can be applied for 20-minute intervals while awake for the first 2 days.
In the post-operative period between the two procedures, you will be provided with pain medications and antibiotics. The antibiotics are to prevent an infection around the wire or in the incisions. Following the second procedure you will no longer have to take an antibiotic. You will be given enough pain medications after the first procedure to take for both procedures.
A representative from Medtronic or Axonics, the company that manufactures the equipment, will be present at both procedures. They do not perform or assist in any aspect of the procedure. They are there to assist you with the technical questions, adjustments and/or problems related to the equipment involved in both procedures. They will review with you how to use the devices and help troubleshoot any issues from the technical side. They are reachable by phone and will help with any technical questions (the equipment is not working; you do not feel the stimulation anymore, etc...).
Post Stage 1 Instructions / Limitations:
Limit your physical activities. This includes:
- No heavy lifting or vigorous exercise
- Avoid bending at the waist. If you must bend, bend at the knees
- Avoid excessive twisting
- Avoid scrubbing floors, vacuuming, heavy housework, flipping mattresses
- No sexual relations
- When moving to and from the bed/ couch /car, etc., try not to slide across the surface
Do not change the dressings. If necessary, you may reinforce the existing dressing with tape.
It is very important to keep the dressing dry and in place. No showers or soaking in a tub. Taking sponge baths is the safest way to stay clean between the two procedures.
Perform your 24-hour voiding diary two days prior to your follow-up visit. We will provide you with the diary and collection device. Try not to alter your normal routine (diet, fluid intake, caffeine, alcohol and medications) during the trial period. Take all medications – antibiotics, pain meds, stool softener, etc - as prescribed.
Post Operative Instructions:
The implanted neurostimulator is located in your buttocks. The neurostimulator is connected to a wire in your lower back called a lead. The neurostimulator and lead parameters will be programmed after the surgery. You will be instructed on the proper use of your patient programmer which allows you to turn the neurostimulator ON or OFF, increase or decrease the amount of stimulation, and change programs based on settings programmed into your programmer.
The stimulation should feel similar to your test stimulation. Although the lead is secured in place, it may move slightly as you change positions, causing stimulation to become more/less intense, and/or change locations. You may need to adjust the stimulation amplitude accordingly. You may turn the stimulation up and down, on and off or change programs (a programmer manual will be provided to you). The amount of stimulation is under your control. Stimulation should be on 24 hours/day and should always be felt. If stimulation becomes painful, turn down the stimulation or turn off the stimulator and call the office.
Restrict activity for 5-6 weeks as much as possible. You have had surgery and have incisions - your body needs time to rest and heal. Being too active too soon can result in the lead wire moving out of position.
You may shower after the first 48 hours.
You will receive a personalized implant identification card in the mail within one month of the surgery. If you do not receive this card please call the Medtronic or Axonics representative.
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Work / Disability
Time out of work, if needed, will be given for two weeks between the two procedures. Due to the volume of patients in our office, we ask that you provide your disability paperwork as soon as possible to be filled out. We will complete and return the paperwork within 3-4 days of our receiving it.
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Driving
Turn off the test stim box and unplug it if you are operating a motor vehicle.
Technical tips with Exterior Stim box:
Although the lead wire is secured inside your body, the wire may move slightly as you change positions and as healing occurs. This may cause the stimulation to become more or less intense or to change in quality or location. This is perfectly normal, but you may need to adjust the strength of the stimulation accordingly.
The intensity of the stimulation is under your control. The stimulation should be as high as possible without being uncomfortable. Ideally, the stimulation should be on 24 hours/day.
Adjustments of the dial may be necessary so that you can feel the stimulation, but never to the point of discomfort. Some patients do not always feel the stimulation continuously. This is OK. Our goal is the improvement of symptoms.
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Restrictions:
- Devices are now MRI-compatible. You may have CT scans, x-rays, fluoroscopy, diagnostic ultrasound
- Avoid Diathermy, energy from diathermy may cause damage to tissue and neurostimulator
- Shut off your neurostimulator when you drive a vehicle or operate heavy equipment
- Avoid massage treatments in the sacral and buttock area
- Use care when near theft detectors and security devices (found in airports, stores and libraries). Shut your stimulator off and show your identification card if necessary.
- Trauma to the neurosimulator is bad and may cause the device to malfunction
- High radiation sources such as cobalt 60 or gamma radiation should not be directed at the stimulator. If this treatment is necessary, shield the device to prevent radiation damage
- The use of high-output ultrasonics or lithotripsy is not recommended. If lithotripsy (crushing of stones in the urinary tract with sound waves) must be used, focus beam at least 6 inches from neurostimulator
- Keep your programmer with you at all times
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