What are the post-operative instructions for patients after InterStim (Interstim, sacral nerve stimulation) implantation for urology?

Post-Operative Instructions for InterStim Implantation in Urology

Following InterStim (sacral nerve stimulation) implantation for urological conditions, patients should follow a structured post-operative care plan that includes wound care, activity restrictions, device management, and follow-up monitoring to ensure optimal outcomes and minimize complications.

Immediate Post-Operative Care (First 24-48 Hours)

• Wound Care:

  • Keep the surgical site clean and dry
  • Avoid showering for the first 24-48 hours
  • Monitor for signs of infection (redness, swelling, warmth, drainage, fever)
  • Do not remove dressings unless instructed by your healthcare provider

• Pain Management:

  • Take prescribed pain medications as directed
  • Pain is typically minimal and can be managed with oral analgesics 1
  • Most patients experience only mild to moderate pain that peaks on postoperative day 1

• Activity Restrictions:

  • Rest for the first 24-48 hours
  • Avoid strenuous activities, heavy lifting (>5 pounds), and bending at the waist
  • Avoid sitting directly on the implantable pulse generator (IPG) site
  • Begin light walking as tolerated to prevent blood clots

Short-Term Post-Operative Care (First 2 Weeks)

• Device Management:

  • Keep the stimulator turned to the lowest setting or off as instructed 2
  • Do not manipulate the device or surgical sites
  • Avoid activities that could twist or strain the implant area
  • Report any sudden loss of stimulation effectiveness immediately

• Activity Progression:

  • Gradually increase activity levels as tolerated
  • Avoid twisting movements that could cause lead migration 3
  • No swimming, bathing, or soaking in water until wounds are completely healed
  • No driving while taking narcotic pain medications

• Voiding Monitoring:

  • Follow a timed voiding schedule every 3-4 hours during waking hours 4
  • Monitor and document voiding patterns and symptoms
  • Report any difficulties with urination or worsening of urological symptoms
  • Measure post-void residual volume if instructed and equipment provided

Medium-Term Post-Operative Care (2-6 Weeks)

• Activity Restrictions:

  • Avoid strenuous exercise, sports, and sexual activity for 4-6 weeks
  • No lifting objects heavier than 10 pounds for 4-6 weeks
  • Gradually return to normal activities as directed by your healthcare provider
  • Avoid activities that involve excessive bending or twisting at the waist

• Device Programming:

  • Attend scheduled programming sessions
  • Learn how to use the patient programmer device
  • Document effectiveness of different stimulation settings
  • Report any unusual sensations or discomfort during stimulation

Long-Term Management

• Device Monitoring:

  • Be alert for signs of lead migration or twisting, which may present as:
    • Sudden loss of effectiveness
    • New or unusual sensations during stimulation
    • Return of pre-implantation urological symptoms 3
  • Check battery status regularly using the patient programmer
  • Schedule regular follow-up appointments for device assessment

• MRI Considerations:

  • Inform all healthcare providers about your InterStim device
  • MRI compatibility varies by device model - carry your device ID card at all times
  • Some newer InterStim models are full-body MRI compatible under specific conditions 2

• Other Medical Procedures:

  • Inform all healthcare providers about your InterStim device before any procedure
  • The device should be turned to the lowest setting or off before any medical procedure
  • Monopolar electrocautery is contraindicated; bipolar cautery is preferred 2

Warning Signs - When to Contact Your Healthcare Provider

• Signs of infection (increasing redness, warmth, swelling, drainage, fever)
• Severe or worsening pain not controlled by prescribed medications
• Sudden loss of device effectiveness or change in stimulation sensation
• Development of new or worsening urological symptoms
• Any trauma or injury to the implant site
• Visible displacement of the device components

Follow-Up Schedule

• First post-operative visit: 1-2 weeks after implantation
• Device programming sessions: As scheduled by your healthcare provider
• Regular follow-up visits: Every 3-6 months initially, then annually

By following these comprehensive post-operative instructions, patients can maximize the effectiveness of their InterStim therapy while minimizing the risk of complications such as infection, lead migration, or device malfunction.