Neuromodulation in urology, state of the art

Abstract

Sacral neuromodulation is an approved and validated treatment for overactive bladder syndrome, chronic non-obstructive retention, and chronic pelvic pain. Percutaneous tibial nerve stimulation is a less invasive approach of neuromodulation. We performed a literature research to assess the current evidence available about neuromodulation. Both techniques appear to be effective and safe third-line treatments. The overall success rate ranges from 43% to 85% for sacral neuromodulation and from 40% to 79.5% for percutaneous tibial nerve stimulation. Sacral neuromodulation has a higher incidence of complications in comparison to percutaneous tibial nerve stimulation, due to the more invasive surgical technique and the presence of a permanent implant. The incidence of surgical revision ranges between 9% and 33%. The most frequent complication with sacral neuromodulation is pain at implant site (15%–42%), followed by lead migration (4%–21%), pain at lead site (5.4%–19.1%), leg pain (18%), and infection (5.7%–6.1%). The quality of the studies on sacral neuromodulation and percutaneous tibial nerve stimulation in literature is quite modest, because of the shortage of good randomized clinical trial; most of the studies are prospective observational studies with mid-term follow-up.

Neuromodulation in Urology: Current Trends and Future Applications

“…In one survey of SNM patients, satisfaction rates were reported to be over 95% with SNM therapy and were not affected by patient age or any complications or program type, a testament to the efficacy of this treatment [43]. The multitude of data in the literature also attests to the general safety of SNM [44].…”

Update van sacrale neuromodulatie voor functiestoornissen van de lage urinewegen

“…SNM bij blaaspijnsyndroom is onvoldoende onderzocht en ook lange follow-up ontbreekt, vermeldt de EAU-richtlijn. De kans op een succesvolle behandeling van blaaspijnsyndroom is ook duidelijke lager dan van de geregistreerde indicaties, met een slagingspercentage van de proefbehandeling van rond de 40% [9,13,14]. SNM zou kunnen worden ingezet alvorens over te gaan op meer invasieve behandelingen (niveau van bewijs 3; niveau van de aanbeveling zwak), of bij patiënten die ook overactiviteit of blaasledigingsproblematiek hebben [9,[15][16][17].…”

Evolving types of pudendal neuromodulation for lower urinary tract dysfunction

“…Sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) are effective and safe third-line treatments for OAB. Their overall success rates range from 43 to 85% and 40 to 79.5%, respectively [ 7 ]. SNM has been used for refractory OAB ‘dry’ (without urinary incontinence) and ‘wet’ (with urinary incontinence) for more than 2 decades, with success rates of 70–80%, similar to those of intravesical botulinum toxin [ 8 ].…”