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Thompson JH, Sutherland SE, Siegel SW. Sacral neuromodulation: Therapy evolution. Indian J Urol. 2010;26(3):379-84doi: 10.4103/0970-1591.70576.
Thompson, J. H., Sutherland, S. E., & Siegel, S. W. (2010). Sacral neuromodulation: Therapy evolution. Indian journal of urology : IJU : journal of the Urological Society of India, 26(3), 379-84. https://doi.org/10.4103/0970-1591.70576
Thompson, Jannah H, et al. "Sacral neuromodulation: Therapy evolution." Indian journal of urology : IJU : journal of the Urological Society of India vol. 26,3 (2010): 379-84. doi: https://doi.org/10.4103/0970-1591.70576
Thompson JH, Sutherland SE, Siegel SW. Sacral neuromodulation: Therapy evolution. Indian J Urol. 2010 Jul;26(3):379-84. doi: 10.4103/0970-1591.70576. PMID: 21116359; PMCID: PMC2978439.
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Indian J Urol. 2010 Jul;26(3):379-84. doi: 10.4103/0970-1591.70576.

Sacral neuromodulation: Therapy evolution.

Indian journal of urology : IJU : journal of the Urological Society of India

Jannah H Thompson, Suzette E Sutherland, Steven W Siegel

Affiliations

  1. Metropolitan Urology, Cornerstone Medical Specialty, 6025 Lake Road, Suite 100, Woodbury, MN, USA.

PMID: 21116359 PMCID: PMC2978439 DOI: 10.4103/0970-1591.70576

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.

Keywords: Refractory overactive; neuromodulation; non-obstructive

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