Test Appointment Date and Time: ___________________

Special Instructions:______________________________

_______________________________________________

Your physician has recommended that you receive an InterStim® Test. This is a simple test that allows the physician to determine the root cause of your urinary dysfunction.

Why You Need an InterStim® Test:

Reasons that your physician is offering you this test may included one or more of the following common problems:

• You may be incontinent (leak urine)
• Your bladder may not empty completely or at all
• You may have the frequent or constant urge to urinate
• Your urine stream may be weak or intermittent
• You have difficulty making it to the restroom due to a sudden urge to urinate

Two Common Causes of Urinary Dysfunction:

There are two main causes of urinary dysfunction: muscles (motor function) and nerves (sensory function). Medications are used to treat muscle dysfunction. If two or more medications have not been successful at treating your urinary problems then an InterStim® Test is used to determine if the cause of your urinary dysfunction is a sensory (nerve) issue.

What Will Happen During Your Test?

Two tiny test wires will be placed underneath your skin near your tailbone. No incisions are necessary to place the wires. Your test will provide valuable data on your bladder dysfunction so your physician can make the best recommendation for treatment. If the test is successful then you will experience a significant improvement in current bladder symptoms.

How long should I plan on being in the office?

You should plan on being in the office about 1-1.5 hours- although the procedure itself should take less than 30 minutes.

What happens after the procedure?

You will go home with a temporary external stimulator with little wires taped to your lower back. You may not get the tape, wires or stimulator wet during your test. We recommend sponge baths. You will be asked to record your voiding habits in a voiding dairy throughout the duration of the trail. The test period usually last between 4-7 days. You will usually see results in the first 12-48 hours of your test.

What happens if the test does not work?

The office procedure has a 70% success rate. There are times when the test wires will move and you can get an inconclusive test. If this happens, your physician will determine whether or not to have a more sturdy wire placed in the hospital to test your nerves.

What happens if I have a successful test?

If you see a 50% or greater improvement in your symptoms, your test is successful. You then go back to the office and get your test wires pulled out. This is painless and takes about a minute. You then will be informed of the next step by your physician.

What if I have questions during the InterStim® test?

With any medical questions, you need to contact your physician’s office. Your therapy consultant will follow up with you the next day to answer any device related questions.