Sacral nerve stimulation for neuromodulation of the lower urinary tract

Abstract

Patients with symptoms of overactive bladder syndrome or non-obstructive urinary retention, refractory to conservative therapy, can nowadays be treated minimally invasively with sacral nerve stimulation (SNS). The use of electric currents to treat urological pathology has a long history but SNS therapy only received FDA approval in 1997. The mechanisms of action are still not known so there are different theories explaining the modulation effect. Recent studies have shown a central modulation effect. Predictive factors which can help to identify the perfect candidates are not known. Over the years the technique of SNS has become less invasive and because of two stage implantation test results have proven to be more reliable. The clinical results for this therapy have proven to be safe and effective and with the technical improvements over the years the re-operation and complication rates have decreased significantly. The clinical results have led to expanding indications because of positive effects in other symptoms. In the field of urology this has resulted in the use of SNS therapy for interstitial cystitis, neurogenic lower urinary dysfunction, and pediatric voiding dysfunction. In the field of gastro-intestinal pathology, SNS therapy is used to treat faecal incontinence and constipation.

Sacral Neuromodulation: Does It Affect the Rectoanal Angle in Patients with Fecal Incontinence?

“…Sacral neuromodulation (SNM) has emerged as a successful treatment for urinary voiding disorders and lower bowel motility disorders in recent years [1, 2]. However, understanding and knowledge about the underlying mechanism of action for urological disorders as well as lower bowel motility disorders remains limited.…”

A Cadaveric Study on the Efficacy of Surface Marking and Bony Landmarks Used in Sacral Neuromodulation

“…Neuromodulation can be practiced in any of the sacral nerves, but the lower ones are more preferred, as the incidence of the nerve root and vascular structures greatly increases in the higher sacral nerves when compared to the lower ones [ 17 ]. A procedure at the level of S3 produces the best motor response [ 18 ]. In a study conducted by Hasan et al .…”

Long-term Outcomes of Sacral Nerve Stimulation in Pelvic Floor Dysfunctions

“…Sacral nerve stimulation (SNS) is a well-established treatment for patients with chronic bowel or voiding dysfunction who do not respond to first- or second-line treatments (dietary and lifestyle modifications, pharmacotherapy, and pelvic floor muscle training) [ 1 ]. This heterogeneous group of pathologies includes overactive bladder (OAB) with or without urinary incontinence, chronic nonobstructive urinary retention (UR), and fecal incontinence (FI).…”