Applications of neuromodulation of the lower urinary tract in female urology

Abstract

Neuromodulation is becoming part of clinical armamentarium for treatment of a variety of lower urinary tract conditions in female urology. Its increased usage stems from need of patients who have exhausted all other therapeutic options for their complex and poorly understood lower urinary tract disorders. Currently neuromodulation may consist of the use of sacral nerve stimulation (SNS) and injectable therapies. Herein, we will discuss the background and development of SNS, its current indications, methods of patient selection and will review the results of the recent published literature on SNS. In addition, we will discuss some of the newer developments in SNS such as Bion device and the future direction in integration of SNS in female urology.

Advances in the role of sacral nerve neuromodulation in lower urinary tract symptoms

“…Typical S3 stimulation results in bellows movement of the pelvic floor, plantar flexion of the great toe, and paraesthesia in the rectum, perineum, scrotum, or vagina. Stimulation of the other sacral roots results in different motor responses: S2 gives clamp movement or twisting and pinching of the anal sphincter plantar flexion of the entire foot, lateral rotation; S4 stimulation results in bellows motion of the pelvic floor, no lower extremity activity, and a sensation of pulling in the rectum [33]. …”

Sacral nerve stimulation for neuromodulation of the lower urinary tract

“…Stimulation of the other sacral roots results in different motor responses: S2 stimulation results in clamp movement or twisting and pinching of the anal sphincter and plantar Neurourology and Urodynamics DOI 10.1002/nau flexion with lateral rotation of the entire foot; S4 stimulation results in bellows motion of the pelvic floor, no lower extremity activity and a sensation of pulling in the rectum. 40 It can be difficult to palpate the bony landmarks necessary to identify the right puncture place in obese patients. Fluoroscopy can then be used for S3 localization.…”