Sacral neuromodulation: Therapy evolution

Abstract

Objectives:Sacral neuromodulation has gained increased worldwide acceptance as the standard of care in patients with refractory overactive bladder (OAB) and non-obstructive urinary retention (NOUR). This review will detail the evolution of the technology.Materials and Methods:The mechanism of action and advances in treatment, including tined lead, fluoroscopic imaging, and smaller implantable pulse generator (IPG) are reviewed. This discussion also explores expanding indications and future advances including interstitial cystitis, chronic pelvic pain, neurogenic bladder, fecal incontinence, constipation, and dysfunctional elimination syndrome in children.Results:Sacral neuromodulation (SNM) exerts its influence by modulation of sacral afferent inflow on storage and emptying reflexes. The tined lead allows for placement and stimulation to be performed in the outpatient setting under local anesthesia with mild sedation. Lead migration has been minimal and efficacy improved. The use of fluoroscopy has improved accuracy of lead placement and has led to renewed interest in bilateral percutaneous nerve evaluation (PNE). Bilateral PNE can be performed in the office setting under local anesthesia, making a trial of therapy less expensive and more attractive to patients. A smaller IPG has not only improved cosmesis, but decreased local discomfort and need for revision. The role for SNM continues to expand as clinical research identifies other applications for this therapy.Conclusions:Our understanding of SNM, as well as technological advances in therapy delivery, expands the pool of patients for which this form of therapy may prove beneficial. Less invasive instrumentation may even make this form of therapy appealing to patients without refractory symptoms.

Sacral nerve stimulation: 50 years in the making

“…There have been advances in treatment, including a tined lead, the use of fluoroscopic imaging and the smaller implantable pulse generators. 3 The indications for SNM have also grown to include interstitial cystitis, chronic pelvic pain, fecal incontinence, constipation and neurogenic bladder. [4][5][6][7][8] With these therapeutic changes researchers have searched for less invasive modalities to stimulate these sacral nerves.…”

Sacral Neuromodulation: A Worldwide Survey Conducted Among Surgeons

“…Sacral Neuromodulation (SNM) with the InterStim® system therapy (Medtronic Inc., Minneapolis, Minnesota USA) has been a US Food and Drug Administration (FDA)-approved medical device for urgency-frequency syndrome since 1997, and for idiopathic non-obstructive urinary retention since 1999 [1]. Additionally, it was approved for voiding dysfunction by Health Canada in February 2002 (Class IV, License No.…”

“…Also, it appears to restoring brainstem auto-regulation [6]. However, there have been several innovations in its surgical techniques methodology since the initial FDA approval in 1997 [1]. At the time of the initial FDA approval, there were very few surgeons who possessed versatile surgical techniques in this field in North America and Europe.…”

“…Additionally, it was approved for voiding dysfunction by Health Canada in February 2002 (Class IV, License No. 14962) [1,2].…”

Convergence and cross talk in urogenital neural circuitries

“…Electrical stimulation of various nerves has been used to inhibit and activate bladder reflexes of animals (Snellings and Grill 2012;Su et al 2012a;Woock et al 2010) and as a therapy area that has been designed for use with both idiopathic and neurogenic bladder disorders (Chartier-Kastler 2008;Kennelly et al 2011;Light 1993;Middleton and Keast 2004;Schmidt et al 1999;Thompson et al 2010). Electrical stimulation of the DNP or the dorsal nerve of the clitoris (DNC) can also be used to activate MRF neurons to mimic sexual sensory inputs (Hubscher 2006;Hubscher and Johnson 1996).…”