New Technologies and Applications in Sacral Neuromodulation: An Update

Abstract

Recently rechargeable devices have been introduced for sacral neuromodulation (SNM) with conditional safety for full-body magnetic resonance imaging (MRI). Currently a recharge-free SNM device represents the standard implant; however, it is only approved for MRI head scans. As further new technologies with broader MRI capabilities are emerging, the advantages as well as disadvantages of both rechargeable versus recharge-free devices will be briefly discussed in this commentary from the perspective of patients, healthcare professionals, and providers.

Systematic Literature Review and Meta-Analysis of Sacral Neuromodulation (SNM) in Patients with Neurogenic Lower Urinary Tract Dysfunction (nLUTD): Over 20 Years’ Experience and Future Directions

“…Since new full-body MRI-safe devices have become recently commercially available for 1.5 T and 3 T (Axonics, Irvine, CA and Medtronic, Minneapolis, MN), more patients with MS could gain access to this minimally invasive, reversible treatment. New SNM technologies with smaller rechargeable devices (Axonics r-SNM, 5.5 cm 3 ; Medtronic InterStim Micro, 2.8 cm 3 ) with an expected battery life of up to 15 years [ 14 ] offer significant advantages for patients with a need for high stimulation amplitudes, which is not rare among the neurological patient population. In their case series, Minardi et al observed a mean amplitude of 3.6 V (range 2.3–5.8 V) for patients with MS [ 44 ] resulting in a mean battery life of approximately 5 years.…”

“…In the current guidelines of the European Association of Urology (EAU) SNM has been described as a treatment for nLUTD, but without concrete guidance or recommendations [ 13 ]. The recently introduced new full-body magnetic resonance imaging (MRI)-safe SNM devices [ 14 ] will offer broader access to a patient group that has often been considered as a contraindication due to the need for regular MRI investigations. For example, in a population-based study of patients with MS, prevalence rates of lower urinary tract symptoms or fecal incontinence were high, at 75% and 29%, respectively [ 15 ].…”

Two‐year outcomes of the ARTISAN‐SNM study for the treatment of urinary urgency incontinence using the Axonics rechargeable sacral neuromodulation system

“…Benefits of using a rechargeable system include a reduced number of revision/replacement surgeries (due to the small INS size and device life of 15 years) as well as potentially increased patient comfort and projected lower healthcare costs 19 . This study shows that high patient satisfaction and significant, durable symptom reduction can be achieved with the rechargeable Axonics System without the significant tradeoffs historically reported for rechargeable systems 13,20 . Reasons for high satisfaction with recharging may include unique aspects of the Axonics rechargeable System, such as the small device size, the low recharging burden (short duration of recharging), and optimal implanting INS technique.…”

Fowler’s Syndrome—The Cause of Urinary Retention in Young Women, Often Forgotten, but Significant and Challenging to Treat

“…The future of neuromodulation is tempting. Miniaturized, rechargeable devices that are safe during full-body MRI scans are being introduced to the market [ 37 ]. It is possible that, in the future, wireless devices generating kHz frequencies capable of blocking pudendal nerve conduction will also be used in the treatment of detrusor sphincter dyssynergia (DSD) in people with spinal cord injuries [ 38 ].…”