Sacral Nerve Stimulation (Sacral Neuromodulation)

Sacral nerve stimulation uses a thin electrode placed beside a sacral nerve, usually S3, and a small pacemaker-like generator under the skin of the upper buttock. Gentle electrical pulses modulate the nerve signals that pass between the bladder, bowel, pelvic floor and brain.

It can greatly reduce urgency and leakage in overactive bladder, help some people with non-obstructive urinary retention to void, and reduce faecal incontinence. It works in about two thirds of those tested, which is why a trial phase comes first, and it needs lifelong device follow-up.

What Sacral Nerve Stimulation (Sacral Neuromodulation) involves

Treatment has two stages. In the test stage you lie face down and, under local anaesthesia with sedation, a needle is passed through a sacral foramen using X-ray guidance. Correct placement is confirmed by a tightening of the pelvic floor and a bend of the big toe. A tined lead with four contacts is slid into place and connected through an extension wire to an external stimulator worn on a belt. You keep a bladder or bowel diary for 1 to 3 weeks. If symptoms improve by at least half, the second stage, a 30-minute procedure, connects the lead to a permanent generator in a pocket under the buttock skin. If not, the lead is removed.

Who is a good candidate for Sacral Nerve Stimulation (Sacral Neuromodulation)?

It is a third-line treatment, offered after conservative measures and medication have not worked.

• Overactive bladder with urgency incontinence not controlled by bladder training and at least two medicines
• Non-obstructive urinary retention, including Fowler's syndrome in women
• Faecal incontinence persisting after diet, medication and pelvic floor therapy
• People who prefer a reversible option to bladder botulinum toxin injections or major surgery

It is usually not the right choice if:

• Stress urinary incontinence, which needs a different treatment
• Retention caused by a physical blockage such as an enlarged prostate or stricture
• Progressive neurological disease or complete spinal cord injury, where results are poor
• People unable to operate the patient controller, or likely to need frequent MRI if a non-conditional device is proposed
• Pregnancy; the device is switched off if you conceive

Technique options

• Staged tined-lead trial: The most reliable test, lasting 1 to 3 weeks with the definitive lead.
• Percutaneous nerve evaluation (PNE): A simple temporary wire placed in clinic for a few days. Quicker, but the wire can move and give a false negative.
• Rechargeable generator: Smaller, lasts 15 years or more, needs charging through the skin every week or two.
• Recharge-free generator: Larger, lasts roughly 5 to 10 years, then is replaced in a short procedure.

What happens during your treatment

Each stage takes 30 to 60 minutes under local anaesthesia with sedation or a light general anaesthetic. During lead placement you may be asked what you feel: a tapping or pulling sensation in the perineum is the right response. You go home the same day. The stimulation is felt as a faint flutter, or not at all once settled.

Preparing for your trip

Plan for 2 to 4 weeks to complete trial and implant, or two trips in Istanbul. Your surgeon reviews photographs and your medical history before you book, and you meet in person the day before surgery for examination, marking and consent with a professional interpreter.

• Stop smoking and nicotine at least four weeks before and after surgery; it is the single biggest avoidable cause of wound problems
• Tell the team about every medicine and supplement you take; blood thinners, some herbal products and hormone treatment may need to be paused on your doctor's advice
• Arrange for someone to travel with you or to be reachable, and keep the first days at home free of work and lifting
• Book a changeable return flight; your surgeon confirms when you are fit to fly

Recovery and results

Wounds heal in about 2 weeks. For 6 weeks avoid bending, stretching, heavy lifting and sport so the lead does not move. After that, normal activity including swimming is fine. Programming adjustments are common in the first months. You carry a device card for airport security, and should tell any doctor ordering an MRI or using diathermy.

• Back to everyday activity: A few days; activity limits for 6 weeks
• When results show: Within days of the trial starting
• How long they last: Battery 5 to 15 or more years; effect sustained in most responders

Safety, risks and revision policy

It is low-risk surgery, but device problems over the years are fairly common and about a third of people need a revision.

• Pain at the generator or lead site
• Lead migration with loss of effect, needing repositioning
• Infection, which usually requires removing the device
• Loss of benefit over time despite reprogramming
• Unpleasant stimulation in the leg or perineum, usually corrected by reprogramming
• Battery depletion requiring a replacement procedure
• Restrictions on MRI depending on the model

Every written proposal arranged through Clinic-Y states what the clinic covers if a correction is needed. Ask for it before you book, not after.

Cost of Sacral Nerve Stimulation (Sacral Neuromodulation) in Türkiye

Clinic-Y does not publish a single price for Sacral Nerve Stimulation (Sacral Neuromodulation), because the honest figure depends on your case. What moves it:

• The implant itself, which dominates the price, and whether it is rechargeable
• Two-stage procedure with theatre and X-ray time
• Urodynamic or anorectal tests beforehand
• Programming visits
• Future battery replacement

Send your photographs or reports and you receive written, all-inclusive proposals from suitable teams, side by side. Reviewing your case is free.

Frequently Asked Questions