The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on sacral nerve stimulation for urge incontinence and urgency-frequency.
It replaced the previous guidance on sacral nerve stimulation for urge incontinence (Interventional Procedures Guidance no. 4, August 2003) after the Interventional Procedures Advisory Committee reconsidered the procedure based on the results of a systematic review commissioned by NICE.
Further recommendations have been made as part of the clinical guideline on lower urinary tract symptoms published in May 2010, as follows:
- Consider offering implanted sacral nerve stimulation to manage detrusor overactivity only to men whose symptoms have not responded to conservative management and drug treatments.
Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. More information is available from NICE guideline CG97. The IP guidance on sacral nerve stimulation for urge incontinence and urgency-frequency remains current, and should be read in conjunction with the clinical guideline.
Sacral nerve stimulation is used in the management of severe urinary urge incontinence, a condition in which a strong urge to urinate is followed by an involuntary loss of urine.
Urge incontinence occurs more commonly in women and the elderly. The procedure involves placing electrodes and connecting them to an implantable pulse generator.
A70.1 Implantation of neurostimulator into peripheral nerve
A70.2 Maintenance of neurostimulator in peripheral nerve
A70.3 Removal of neurostimulator from peripheral nerve
A70.4 Insertion of neurostimulator electrodes into peripheral nerve
In addition to one of the above OPCS-4 codes the following site code would be assigned:
Z11.2 Sacral nerve
Note: OPCS-4 code Y70.5 Temporary operations would be assigned in addition to A70.4 Insertion of neurostimulator electrodes into peripheral nerve if temporary electrodes are inserted to test whether the intervention is likely to be effective, but the pulse generator device is not implanted under the skin.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.