Confirm the diagnosis
A bladder history, examination, urine testing, bladder diary, and assessment of emptying help exclude other causes of symptoms.
Conditions & treatments
Bladder neuromodulation
Sacral Neuromodulation
A staged treatment that uses gentle electrical stimulation of a sacral nerve to modify bladder signalling in selected patients.
Medical information: This is general information and does not replace professional medical advice.
Understanding the treatment
Clinical overview
Sacral neuromodulation uses a small implanted system to stimulate a sacral nerve involved in bladder and pelvic-floor control. It may be considered when conservative treatment and medication have not provided adequate relief or have caused unacceptable side effects.
The treatment is staged. A test phase allows symptoms to be measured before a permanent device is considered. Proceeding to implantation depends on the patient’s response, goals, and clinical assessment; improvement is not guaranteed.
Interactive diagram
The two-stage neuromodulation pathway
A simplified back view of the sacrum showing the S3 nerve and how the trial and implant stages differ.
Hover over or select a label to read a short description.
The S3 sacral nerve
The sacral nerves carry signals between the spinal cord, bladder, bowel and pelvic floor. The S3 nerve is usually the target.
This is general information and does not replace professional medical advice.
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Explaining the device
Close-up of Prof Jeffery holding a demonstration neuromodulation device or programmer while explaining it across the desk. Focus on hands and device.
Before treatment
Assessment and shared decision-making
Treatment is planned only after the diagnosis, alternatives, expected benefits, limitations, and relevant risks have been discussed.
Review previous treatment
Bladder training, pelvic-floor care, medicines, and other appropriate options are reviewed before neuromodulation is considered.
Plan the test phase
The temporary testing method, symptom goals, daily recording, activity precautions, and the criteria for considering implantation are explained.
Plan long-term care
Device checks, battery life, future procedures, MRI conditions, and the possibility of revision or removal are discussed.
Treatment pathway
The staged treatment pathway
The test phase is an important part of treatment because it provides individual evidence of response before a permanent implant is placed.
01
Baseline diary
Bladder symptoms are recorded before testing so that any change can be assessed against the patient’s own baseline.
02
Test stimulation
A fine lead is positioned near a sacral nerve and connected to an external stimulator for a defined assessment period.
03
Review the response
Diary findings, symptom change, comfort, and patient goals are reviewed. A test that does not provide sufficient benefit is stopped.
04
Implant and programming
If the test is clinically worthwhile, an implanted pulse generator may be placed and adjusted over follow-up visits.
Informed consent
Risks and limitations
All procedures carry risks. Individual risk varies with health, anatomy, previous surgery, and the planned treatment.
- Pain, bleeding, bruising, infection, or wound problems
- Lead movement, device malfunction, loss of benefit, or uncomfortable stimulation
- Need for reprogramming, battery replacement, revision, or removal
- Temporary activity restrictions during lead healing
- MRI and other procedure precautions depend on the implanted system
- Symptoms may not improve sufficiently or benefit may reduce over time
Practical guidance
Recovery and follow-up
Test phase
A bladder diary is kept while the temporary system is used and the lead site is protected.
After implantation
Activity is restricted initially to reduce the chance of lead movement while tissues heal.
Programming
Settings are adjusted according to symptoms and sensation; more than one visit may be needed.
Long-term review
The device, battery, symptom control, and any need for reprogramming are reviewed over time.
Related information
Take the next step
Ready to discuss your options?
Prof Jeffery sees patients at three Cape Town locations. Booking is managed through the Urogynaecology Clinic (ULC).
Booking link takes you to urogynaecology.co.za — managed by the Urogynaecology Clinic team.