Functional urology · London
Sacral neuromodulation (InterStim) - London.
A two-stage implant pathway for refractory overactive bladder, non-obstructive urinary retention and faecal incontinence - by a consultant functional urologist, in a specialist pelvic-floor unit, with a proper Stage 1 trial before you commit.
Why patients choose us
- 01
A named functional urologist, in a specialist pelvic-floor unit
Not a general urology list. A consultant with a high sacral neuromodulation implant volume, in a unit that runs a full functional and pelvic-floor service.
- 02
A proper trial before you commit
A two-stage pathway with a real evaluation window. If Stage 1 does not deliver a 50% improvement, you do not proceed to a permanent implant.
- 03
Independent, and free
We are paid by no clinic and no device company, so the recommendation is impartial and costs you nothing.
What it is
Low-amplitude stimulation of the S3 nerve root - modulating a reflex, not cutting anything.
A pacemaker for the pelvic floor. A small implantable pulse generator sends gentle electrical pulses to the S3 sacral nerve, resetting the reflex arc that drives bladder and bowel behaviour.
How the therapy works
A quadripolar lead is placed through the S3 foramen so its electrodes sit alongside the sacral nerve root. An implantable pulse generator, tucked under the skin of the upper buttock, delivers continuous low-amplitude stimulation. This modulates the sacral spinal reflex that controls detrusor overactivity, urethral behaviour and anorectal function. It does not cut, ablate or destroy any tissue.
The devices we implant
Medtronic InterStim II is the long-established non-rechargeable device, with a 4 to 5 year battery. InterStim Micro is a smaller rechargeable device with a 15-year projected life and full-body 1.5T MRI conditional labelling. Axonics R20 is a rechargeable alternative with a 20-year projected life. We are not tied to any manufacturer and select based on your MRI needs, willingness to recharge, and the consultant\'s implant experience.
Indicative pricing
What private sacral neuromodulation costs in London.
Indicative ranges across our London partner units, split by stage. Send your case and we quote firm figures across two or three options.
In short
Full two-stage InterStim pathway in London: £22,000–£38,000, most patients home the same day.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Functional urology consultation and assessment | £350–£650 | 45–60 min | Same visit |
| Stage 1 evaluation (tined lead + external stimulator) | £6,500–£10,000 | 45–75 min | 2–4 week trial |
| Stage 2 permanent IPG implantation (InterStim II) | £16,000–£24,000 | 45–60 min | Day case |
| Stage 2 permanent IPG (InterStim Micro rechargeable) | £20,000–£28,000 | 45–60 min | Day case |
| Full two-stage pathway (evaluation + permanent) | £22,000–£38,000 | Two visits | 4–8 weeks |
| Battery replacement (non-rechargeable, every 4–5 years) | £9,000–£14,000 | 30–45 min | Day case |
Prices vary by unit, by which consultant does the case, by which device is used, and by whether you are covered by private medical insurance. We come back with a firm quote within one working day.
Efficacy
60 to 80% long-term success in the right patients.
When Stage 1 responders progress to Stage 2, long-term outcomes are strong - and sustained. NICE recommends the therapy for both bladder and bowel indications.
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60 to 80% success at 5 years
In Stage 1 responders, meaningful reductions in urgency, frequency, urge incontinence and faecal incontinence are sustained at 5 years and beyond in large registry data.
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NICE recommended
Sacral nerve stimulation is recommended by NICE for refractory OAB (IPG64) and for refractory faecal incontinence (IPG99 and IPG585) when conservative measures have failed.
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A real trial before you commit
The whole point of Stage 1 is protection. If your voiding or bowel diary does not show a 50% improvement, you do not progress to a permanent implant - and you have not lost the option of anything else.
The journey
From referral to permanent implant - two stages, in order.
One team from first message through Stage 1, Stage 2 and long-term device follow-up.
Phase 1 · Before Stage 1
Concierge, off-stage for you
Phase 2 · The two stages
4 to 8 weeks end to end
Phase 3 · After
Long-term device team
- 01
Before
You send us your bladder or bowel history
A short, confidential form. Symptoms, previous medication trials, PTNS or Botox history, and any prior urodynamics or anorectal physiology.
- 02
Before
We come back with a recommendation
Within one working day: whether sacral neuromodulation fits, or whether PTNS, Botox or urodynamic reassessment is the better next step. Indicative price for both stages.
- 03
Before
Stage 1 evaluation is booked
Usually within two to four weeks. A tined lead is placed into the S3 foramen under local anaesthetic with sedation, connected to an external stimulator.
- 04
The stages
The Stage 1 procedure
45 to 75 minutes. Fluoroscopic guidance to the S3 nerve root, confirmation of a good motor and sensory response, and the external device fitted.
- 05
The stages
Two to four weeks with a voiding diary
You wear the external stimulator and keep a bladder or bowel diary. A 50% reduction in symptoms is the threshold for progressing to Stage 2.
- 06
The stages
Stage 2 permanent implantation
A day-case procedure under sedation or light general anaesthetic. The internal pulse generator is placed subcutaneously in the upper buttock and connected to the lead.
- 07
After
Programming and long-term follow-up
Initial programming session at 4 to 6 weeks. Annual device checks. Battery lasts 4 to 5 years for non-rechargeable, up to 15 years for the rechargeable micro.
Typical end-to-end: 4–8 weeks across both stages. Programming: 4–6 weeks post-implant. Device life: 4–5 or 15–20 years.
When it helps
When sacral neuromodulation is the right step - and when it is not.
The indications where NICE and international guidelines support neuromodulation, plus the cases where a different pathway is safer.
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Refractory overactive bladder (OAB)
Urgency, frequency and urge incontinence that has failed at least two antimuscarinics or a beta-3 agonist, plus a course of PTNS. NICE-recommended (IPG64).
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Non-obstructive urinary retention
Chronic urinary retention without outflow obstruction, including Fowler's syndrome in young women. Restores voiding in a majority of well-selected cases.
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Faecal incontinence
Refractory faecal incontinence after failure of conservative measures, biofeedback and dietary work. NICE-recommended (IPG99, IPG585).
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Refractory urge incontinence
Frequent daily leaks that dominate work, sleep and social life, when medication side effects have made drug therapy intolerable.
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Symptoms after failed Botox or PTNS
When intravesical Botox has worn off, been intolerable, or led to clean intermittent self-catheterisation you cannot sustain, sacral neuromodulation is the logical next step.
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Chronic pelvic pain in selected cases
A minority of interstitial cystitis and bladder pain syndrome cases respond to sacral neuromodulation. Considered only after MDT discussion at a specialist unit.
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Mixed bladder and bowel symptoms
Patients with combined urinary urgency and faecal incontinence often gain across both, which single-organ treatments cannot deliver.
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Not for: obstruction, neurogenic, pregnancy
Bladder outflow obstruction, a fully neurogenic bladder, pregnancy or planned pregnancy, and untreated pelvic malignancy are not candidates. We flag these early.
Device and technique options
InterStim II, InterStim Micro or Axonics - the right device for your life.
Three device families, two trial pathways. We match to your MRI needs, your appetite for recharging, and the implant volumes of the consultants we work with.
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Medtronic InterStim II (non-rechargeable)
The original workhorse implantable pulse generator. Battery life around 4 to 5 years depending on programme. MRI head-only 1.5T conditional.
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Medtronic InterStim Micro (rechargeable)
A smaller, rechargeable pulse generator with a 15-year projected battery life. Full-body MRI 1.5T conditional. Needs weekly charging via a wearable belt.
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Axonics R20 (rechargeable, 20-year)
An alternative rechargeable device with a 20-year projected battery life, full-body MRI 1.5T conditional, and a smaller remote controller. Offered in selected UK centres.
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Tined lead (Stage 1 test)
A quadripolar lead with self-anchoring tines placed through the S3 foramen under fluoroscopy. The same lead is retained if you proceed to Stage 2.
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PNE (percutaneous nerve evaluation)
A quicker office-based test with a temporary wire, retained for 3 to 7 days. Cheaper, but a lower positive predictive value than a full tined-lead Stage 1.
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Stage 2 permanent implantation
The tined lead is left in place and connected to the IPG in a small buttock pocket. Day-case under sedation with local, or light general anaesthetic.
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Patient controller and programming
A handheld controller and a smartphone app let you switch programmes, adjust amplitude within limits, and check battery. Clinical programming is set at follow-up.
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Second-opinion review
A specialist review of your urodynamics, bowel physiology and prior treatment history to decide whether sacral neuromodulation is genuinely the right next step.
Compared to alternatives
Where sacral neuromodulation sits in the OAB pathway.
Not a first-line therapy. It sits after antimuscarinics, beta-3 agonists and typically PTNS - and it competes with intravesical Botox.
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Intravesical Botox
6 to 9 months of effect, then a repeat injection. Risk of urinary retention needing clean intermittent self-catheterisation in around 5 to 10%.
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PTNS
Non-invasive weekly then monthly percutaneous tibial nerve stimulation. Good for milder OAB, needs indefinite maintenance sessions.
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Medications
Antimuscarinics and beta-3 agonists. Limited by anticholinergic side effects, cognitive concerns in older patients, and modest efficacy.
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Augmentation cystoplasty
Major reconstructive surgery using bowel to enlarge the bladder. Reserved for the small number of cases refractory to everything else.
Our London network
A small panel of London functional urologists, we picked them.
Consultant implanters with high sacral neuromodulation volumes, at University College London Hospital Private, HCA The Wellington Urology, Cromwell BUPA, King\'s College Hospital Private, The London Clinic, and Guy\'s and St Thomas\' Private. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every implanter in our network.
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Consultant functional urologists and colorectal surgeons with high implant volumes
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Units running a full pelvic-floor MDT with urodynamics and anorectal physiology on site
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Access to both InterStim II, InterStim Micro and Axonics devices, not tied to one supplier
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Programming clinics and 24/7 device troubleshooting for the life of the implant
MRI compatibility
Every implant is MRI conditional - read the small print.
Before any MRI scan, tell the radiographer which device you have. The team will follow the manufacturer\'s conditional protocol, or advise an alternative modality.
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Medtronic InterStim II
MRI head only, 1.5T conditional. Requires the device to be placed in MRI mode by the implant team beforehand. Full-body MRI is not permitted.
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Medtronic InterStim Micro
Full-body MRI 1.5T conditional. A structured MRI protocol from Medtronic is followed. Excludes 3T machines.
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Axonics R20
Full-body MRI 1.5T conditional under the manufacturer's protocol. Also excludes 3T. Preferred if you know you will need repeated MRI scans.
Safety, programming and follow-up
What to expect afterwards - honestly.
Sacral neuromodulation is a well-established, reversible therapy. The things worth planning are the programming window, the low but real revision rate, and the long-term device relationship.
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Local with sedation for Stage 1
Stage 1 is done awake with local anaesthetic and light sedation so the endoscopist can confirm the correct S3 motor and sensory response as the lead is placed.
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Day-case Stage 2
Stage 2 permanent implantation is a day-case procedure under sedation or light general anaesthetic. You go home the same day with a small dressing over the IPG pocket.
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Lead migration in 5 to 10%
The tined lead can shift, causing loss of the sweet-spot stimulation. Usually managed by reprogramming; a small proportion need a lead revision procedure.
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Infection in 3 to 5%
Wound or pocket infection is uncommon but real. Prophylactic antibiotics are given, and a deep infection can require device explantation and later re-implantation.
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Pain at the IPG site in 5 to 10%
A minority of patients report ongoing discomfort at the buttock pocket. Usually settles; occasionally the IPG is repositioned into a deeper or contralateral pocket.
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Revision surgery over 5 to 10 years
Around 15 to 25% of patients need a revision at some point, most commonly for lead issues, battery change, or repositioning.
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Device off for pregnancy
The device is turned off in pregnancy. There is no long-term safety data in pregnancy, and we recommend planning a family before implantation where possible.
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Battery status and recharging
Non-rechargeable IPGs are replaced every 4 to 5 years as a small day-case procedure. Rechargeable devices need weekly top-ups but avoid the replacement surgery.
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Red flags after discharge
Fever, spreading redness at the wound, sudden loss of stimulation, new leg weakness or numbness - call the implant team the same day.
Reading your implant record
Your implant record in four parts. Read the last one first.
The letter the consultant sends after each stage keeps to the same shape - and gives you the MRI details you will need to hand to any radiographer.
A quiet reminder
Device language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the letter before your programming appointment, just ask.
- 01 Header
Indication and prior treatment history
The primary indication (OAB, retention, faecal incontinence), medications and PTNS or Botox already tried, and urodynamic or anorectal physiology findings.
- 02 Technique
Lead placement and stimulation response
Which foramen was used (usually right S3), motor response (bellows and great toe flexion), sensory response, impedances and final lead configuration.
- 03 Findings
Trial outcome and diary response
The percentage improvement in your voiding or bowel diary during Stage 1, and whether the 50% threshold for permanent implantation was met.
- 04 Impression
Programme, follow-up and MRI status
Read this first: your initial stimulation programme, follow-up interval, battery type and MRI conditional labelling to hand to any radiologist.
Recognised by major UK insurers
Cover for sacral neuromodulation varies by insurer and by indication - usually funded when NICE criteria are met. We confirm cover before Stage 1.
Frequently asked
Everything we get asked about InterStim.
Quick answers on the trial, MRI, insurance, battery life, faecal incontinence and reversibility.
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Do I really need the two-stage trial first?
Yes. Stage 1 with a tined lead and external stimulator is the whole point of the pathway. It gives you a real-world trial of at least two weeks with your own voiding or bowel diary, and it only progresses to a permanent implant if you achieve at least a 50% improvement. It protects you from a permanent device that will not work for you.
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Is an MRI still safe once I have an implant?
It depends on the device. InterStim II is 1.5T MRI conditional for head scans only. InterStim Micro and Axonics R20 are full-body 1.5T MRI conditional. Every scan needs to be discussed with the device team beforehand, and the radiographer follows a specific MRI protocol for the implant.
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Will private medical insurance cover this?
Most major UK insurers cover sacral neuromodulation for refractory overactive bladder, non-obstructive urinary retention and faecal incontinence, provided NICE criteria are met and you have failed adequate conservative and medical therapy. We confirm cover with your insurer before booking Stage 1.
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How long does the battery last?
The non-rechargeable InterStim II lasts around 4 to 5 years depending on your programme, then needs a short day-case replacement procedure. The rechargeable InterStim Micro is designed for 15 years, and the Axonics R20 for 20 years, in exchange for weekly charging with a wearable belt.
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Can it help with faecal incontinence as well?
Yes. Sacral neuromodulation is NICE-recommended for refractory faecal incontinence after conservative measures have failed. Around 60 to 80% of well-selected patients see a meaningful reduction in weekly incontinent episodes, and many gain improvement across both bladder and bowel symptoms.
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Can the device be removed if I change my mind?
Yes. The IPG and the tined lead can be explanted as a day-case procedure. It is not a scarring or destructive treatment - the nerve is stimulated, not cut - so removal returns you to your pre-implant baseline over the following weeks.
Ready to talk?
Send us your bladder or bowel history. We come back within a working day.
A consultant introduction to a named London implanter, a firm two-stage quote, and an honest read on whether sacral neuromodulation, Botox or PTNS is your best next step.
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