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- Title
Sacral neuromodulation: Therapy evolution.
- Authors
Thompson, Jannah H.; Sutherland, Suzette E.; Siegel, Steven W.
- Abstract
Objectives: Sacral neuromodulation has gained increased worldwide acceptance as the standard of care in patients with refractory overactive bladder (OAB) and non-obstructive urinary retention (NOUR). This review will detail the evolution of the technology. Materials and Methods: The mechanism of action and advances in treatment, including tined lead, fluoroscopic imaging, and smaller implantable pulse generator (IPG) are reviewed. This discussion also explores expanding indications and future advances including interstitial cystitis, chronic pelvic pain, neurogenic bladder, fecal incontinence, constipation, and dysfunctional elimination syndrome in children. Results: Sacral neuromodulation (SNM) exerts its in fluence by modulation of sacral afferent inflow on storage and emptying reflexes. The tined lead allows for placement and stimulation to be performed in the outpatient setting under local anesthesia with mild sedation. Lead migration has been minimal and efficacy improved. The use of fluoroscopy has improved accuracy of lead placement and has led to renewed interest in bilateral percutaneous nerve evaluation (PNE). Bilateral PNE can be performed in the offi ce setting under local anesthesia, making a trial of therapy less expensive and more attractive to patients. A smaller IPG has not only improved cosmesis, but decreased local discomfort and need for revision. The role for SNM continues to expand as clinical research identifi es other applications for this therapy. Conclusions: Our understanding of SNM, as well as technological advances in therapy delivery, expands the pool of patients for which this form of therapy may prove benefi cial. Less invasive instrumentation may even make this form of therapy appealing to patients without refractory symptoms.
- Subjects
BOTULINUM toxin; ELECTRIC stimulation; RETENTION of urine; ELECTRODES; FLUOROSCOPY; ARTIFICIAL implants; PERIPHERAL nervous system; OVERACTIVE bladder; THERAPEUTICS
- Publication
Indian Journal of Urology, 2010, Vol 26, Issue 3, p379
- ISSN
0970-1591
- Publication type
Article
- DOI
10.4103/0970-1591.70576