Interstim Therapy: Sacral Nerve Stimulation Phase I

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1 Interstim Therapy: Sacral Nerve Stimulation Phase I What is Interstim Therapy? The nerves in your sacrum (lowest part of your spine) control your bladder and bowel. Interstim Therapy is used to treat overactive bladder, urinary retention, bowel incontinence and constipation. This treatment consists of a two-phase placement of a neurostimulator. A neurostimulator is like a pacemaker, with a hand-held patient programmer. A heart pacemaker uses electrical pulses to make the heart beat normally. The interstim pacemaker is placed in the third sacral space to correct the bowel-brain pathway. In Phase I, an external stimulator is placed Outside of the body and carried in a small fanny pack.. In Phase II, the internal portion of the stimulator is placed _under the fat part of the buttocks. Currently, sacral nerve stimulation is not FDA approved for children under the age of 18 years. However, many centers (including our own) are performing this on children. Phase I Surgery The week before surgery: Talk with the doctor if your child takes any medicines. Do not give your child any medicine on the morning of surgery unless your doctor tells you to. Fill out the provided bowel/bladder tracker for 7 days prior to surgery. Bring this to Same Day Surgery on the day of surgery, and give to the Medtronic representative. The surgery nurse will call you 48 hours before the day of surgery. They will go over: o When to stop eating and drinking o When to arrive at the hospital The day of surgery: You will arrive to Same Day Surgery. The doctor and anesthesiologist will check your child to make sure they are ready for surgery. A Medtronic Representative will teach you about the device. The Patient Management Guide prepares you for before and after the procedure. o You will learn how to turn the device on/off. You will learn how to set the intensity until a slight fluttering is felt in the bicycle seat area. After Surgery Your child will be admitted for 23 hour observation. You will start a new Bowel/Bladder symptom tracker on the day of surgery. Keep tracking until your child has Phase II surgery. Bring the tracker with you when you come back to the hospital. You will give it to the Medtronic representative. o If your child has at least a 50% improvement in their symptoms during Phase I then they area good candidate for Phase II.

2 Your child will have at least one x-ray to make sure they are not constipated. The trial phase is 1-2 weeks. During this time, your child can only shower the front side of their body. No tub baths or swimming is allowed. Do not turn up the intensity on the controller. The fluttering feeling will go away after a period of time (usually 2-4 days). This means the body is getting used to the device. Turning up the intensity will not improve symptoms. Incisional Care Phase I About your incision The incision is closed with stitches under the skin, which you cannot see. Steri-strips (white tape) or Dermabond (clear surgical glue) might also be used to close the incision. A gauze dressing is usually put over the incision to provide extra padding. Tegaderm is then put over the gauze to keep the dressing intact. Taking care of your incision Change the dressing and call your colorectal nurse if the dressing becomes soiled, wet or is uncomfortable. Be careful when removing the dressing, so as not to dislodge the probes. Between Phase I and Phase II No strenuous activities (i.e. no gym class, no organized athletic activities, no contact sports) Avoid sudden or excessive bending, twisting and stretching. Also avoid severe impact to the sacral area. CT and X-ray testing is allowed. However, no MRI imaging can be done below the neck. Diathermy (deep heat treatment from electromagnetic energy) is not allowed. If an EKG is needed, be sure the device is turned off so that EKG results are accurate If you are flying home, give your information card to the TSA agent. Supplies to take home o Patient Management Guide o Belt o Controller o Bowel/Bladder Tracker o Dressing Kit: Steri-strips, 2x2 (4), 4x4 (4), and Tegaderm 6 x 8 (2), and directions for changing the dressing

3 When to check in with the colorectal nurse: Call your colorectal nurse on the day after discharge. After that, call every Tuesday and Thursday with updates prior to Phase II. Call the Colorectal Center at if you notice: If bowel or bladder symptoms come back, or if your symptoms do not get better, call your colorectal nurse. Change the dressing and call your colorectal nurse if the dressing becomes soiled, wet or is uncomfortable. Redness and/or pain at incision site Fever (temperature over 100.4) Call us if you have any questions or questions. Your Colorectal Nurse is Contact information: (Phone) ( )

4 Interstim Therapy Phase II Your child is ready to proceed with Phase II if they have had at least a 50% improvement in symptoms.make sure you are filling out the bowel/bladder tracker Before Surgery. Talk with the doctor if your child takes any medicines. Do not give your child any medicine on the morning of surgery unless your doctor tells you to. The surgery nurse will call you 48 hours before the day of surgery. They will go over: o When to stop eating and drinking o When to arrive at the hospital On the day of surgery: Go to the Same Day Surgery area on B3 at the main hospital. o Bring the bowel/bladder tracker form with you and give it to the Medtronic representative The doctor and anesthesiologist will see your child to make sure that they are ready for surgery. A Medtronic representative will teach you about the device. They will give you information about: o how to turn the device on/off o how to set the intensity until a slight fluttering is felt in the bicycle seat area After the surgery, your child will recover in the PACU before being discharged home. After Surgery Start a new Bowel/Bladder Symptom Tracker and complete for 5 days. Send the tracker to your colorectal nurse when it is completed. Your child may shower after 48 to 72 hours. No tub baths or swimming for 2 weeks. You can remove the dressing 3-4 days after surgery. Do not turn up the intensity on the controller. The fluttering feeling will go away after a period of time (usually 2-4 days). This means the body is getting used to the device. Turning up the intensity will not improve symptoms. A post op clinic visit or follow up phone call will be scheduled for 2 weeks after placement of the permanent device. No strenuous activities (i.e., no gym class, no organized athletic activities) for two weeks. Avoid sudden or excessive bending or twisting and stretching. Also avoid severe impact to the sacral area. CT and X-ray testing is allowed. However, no MRI imaging can be done below the neck. Diathermy (deep heat treatment from electromagnetic ecombinenergy) is prohibited. If an EKG is needed, be sure the device is turned off so that EKG results are accurate If you are flying home, give your information card to your TSA.

5 You will need to follow up by phone or in clinic at 3 and 6 months. After that, you will be seen once a year for a battery check. Expect surgical replacement of the device every 5-7 years. Incisional Care The incision is closed with stitches under the skin, which you cannot see. These also may be used to close the incision o Steri-strips (small pieces of white tape) o Dermabond (clear layer of skin glue) Gauze and Tegaderm dressing may be removed 3-4 days after surgery Steri-strips o Should stay in place for at least 1 week after the surgery. o It will usually fall off in 7 to 10 days. o Can be taken off if it is still in place 14 days after the surgery. o Once the dressing is removed Band-Aid can be used Gently wash with soap and water Dermabond o No special care needed o Will slowly peel off over time Call the Colorectal Center at if your child has: A return of their bowel or bladder symptoms, or if the symptoms do not get better Drainage, redness and/or pain at incision site Fever (temperature over 100.4) Your Colorectal Nurse is Contact information: (Phone) ( )