Description of Interstim Test Implant Peri-op Instructions
InterStim therapy is a pacemaker for the bladder used to reestablish appropriate nueromodulation of the bladder. The device works by using a stimulator device in the buttocks to stimulate the S3 nerve root in the back. This is the primary nerve root for bladder function. Stimulating the S3 nerve root with the InterStim device can result in a dramatic decrease in frequency, urgency and urge incontinence. InterStim therapy can also improve bladder emptying and result in decreasing post void residuals and therefore decreasing urinary tract infections and the other complications of incomplete bladder emptying. InterStim therapy can also be used to treat interstitial cystitis and pelvic pain. Outcomes for interstitial cystitis and pelvic pain are not as predictable as outcomes for frequency, urgency and urge incontinence.
For patients with significant symptoms of frequency, urgency, and urge incontinence who have tried anticholinergic medications but are not getting satisfactory results or cannot tolerate these medications InterStim therapy is an excellent choice. The two-step process of implanting an InterStim device requires a significant amount of time and energy on the part of the patient. The two steps include a simple test stimulation in the office or surgery center to gauge whether the patient is appropriate for InterStim therapy followed by subsequent implantation of the InterStim lead and the InterStim generator.
If you are scheduled to undergo Interstim Test Implant:
- Possible risks of Interstim Implant:
After this type of procedure a small risk of infection exists. You should receive antibiotics to begin taking the day before or the day of the procedure.
Another risk of Interstim is failure to respond. Some patients will not respond to Interstim. Another undesirable response to Interstim is pain with stimulation.
The first step for InterStim therapy is a simple test stimulation in the office or in the surgery center with IV sedation. Tiny wires are implanted into the small of the back near the S3 nerve and these tiny wires are connected to a generator box worn on the hip. The patient wears this box and these tiny wires over the ensuing week and tests one side and then the other for improvements in voiding symptoms. The wires are easily removed in the office and the results can be reviewed to determine if the patient should proceed to the next step. Sometimes only one test wire is placed. In this situation you will simply stimulate this single wire for the entire testing period.
The second step in InterStim therapy is placing the InterStim leads and generator. The InterStim leads are placed in the same location as the test wires. That is, the InterStim leads are placed near the S3 nerve root in the lower part of the back with the patient lying on their abdomen. For this second step, the patient is under IV sedation. With IV sedation the patient is sleepy but able to answer some simple questions at certain times during the procedure.
Preparation for Test Implant:
If your procedure is scheduled for the operating room (surgery center or hospital), you should remain NPO (nothing per OS, or mouth) after midnight the night before surgery. That is, do not let anything pass your lips after midnight before surgery. Do not take blood thinners (aspirin, advil, motrin, ibuprofen, Coumadin, or plavix) for ten days prior to surgery. If your procedure is in the operating room you will also need someone to drive you home. If your procedure is in the office, you will not be required to remain NPO nor will you be required to have a driver.
Post-op:
You will have some pain and swelling at the S3 insertion site in the lower back but there should be minimal swelling.
You will be shown by a Medtronic company rep how to use the external control device to regulate the test stimulation. The rep will also give you his/her contact phone number for any questions. You can also check out Medtronic on the web at www. Medtronic.com . You should take notes on your response during the test period. For instance, you should take detailed notes for yourself about the frequency and approximate volume of your urination.
Generally, if you have a positive response you will move forward with formal lead and generator implantation.
