Although morbidity and the need for revisional surgery are high, the artificial bowel sphincter can improve anal incontinence and quality of life in patients with severe fecal incontinence.

Standardization of electrode placement may ensure close electrode proximity to the target nerve providing a higher likelihood for optimal effect with less energy consumption (better battery longevity), more programming options with more electrode contacts close to the nerve and reduced likelihood of side-effects. The potentially better clinical outcome needs to be demonstrated.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

ResultsThe present recommendations, based on the most relevant data available in the literature, as well as expert opinion, address a variety of specific and at times problematic issues associated with SNM. These include the use of SNM for a variety of underlying conditions, need for pre-procedural testing, use of staged vs single-stage procedures, screening for success during the trial phase, ideal anesthesia, device implantation, post-procedural management, trouble-shooting loss of device function, and future directions for research. Conclusions:These guidelines undoubtedly constitute a reference document, which will help urologists, gynecologists, and colorectal surgeons optimize their use of SNM for refractory urinary urgency and frequency, UUI, NOR, and FI.• Eight urologists, three colorectal surgeons and two urogynecologists, covering a wide breadth of geographic and specialty interest representation, met for two days in Chicago, Illinois, USA on January 19-20, 2017 to discuss best practices for neuromodulation. Suggestions for statements were submitted in advance and specific topics were assigned to committee members. Committee members prepared each assigned topic and presented supporting data to the group at which time each topic was discussed in depth. Best practice statements were formulated based on available data and expert opinion and then each member prepared a discussion section for each particular topic which reflected the current literature and expert opinion. Another urologist was added to the group during the initial writing process. After multiple rounds of editing within the group the highlights of the statements were presented at the ICS meeting in Florence, Italy in September 2017. This document was then circulated to multiple external reviewers after which final edits were made and approved by the group.• The meeting and editing expenses were supported by the ICS. Funding to support this project was based on an unrestricted society-initiated grant made by Medtronic to the ICS.• As many of the recommendations herein are based on expert panel consensus, the recommendations in this document, while meant to aid clinical decision-making, do not preempt physician judgment in individual cases.The statements and recommendations included in this document pertain to SNM in its present form (Interstim, Medtronic) They may or may not have relevance for future SNM products or therapies which become available for clinical use.

These guidelines undoubtedly constitute a reference document, which will help urologists, gynecologists, and colorectal surgeons optimize their use of SNM for refractory urinary urgency and frequency, UUI, NOR, and FI.