Sacral neuromodulation for lower urinary tract dysfunction and impact on erectile function.

Area of Science:

• Urology
• Neurology
• Sexual Medicine

Background:

• Sacral nerve stimulation (SNS) initially targeted voiding dysfunction, including urinary incontinence and retention.
• Emerging evidence suggests potential benefits of SNS beyond lower urinary tract symptoms.
• Sacral neuromodulation (SNM) is an established therapy for various lower urinary tract symptoms.

Purpose of the Study:

• To investigate the efficacy of sacral neuromodulation (SNM) using the InterStim system in improving erectile function.
• To assess changes in erectile function in males undergoing SNM for lower urinary tract symptoms (LUTS).

Main Methods:

• A cohort of 54 males with LUTS and erectile impairment (IIEF-5 score) underwent permanent SNM.
• Patients with normal sexual hormone levels and positive response to intracavernosal injection were included.
• Erectile function was assessed using the International Index of Erectile Function (IIEF-5) pre- and post-SNM implantation.

Main Results:

• Overall, 22 subjects (42.3%) had baseline erectile impairment; 14 were neurogenic.
• Post-SNM, seven patients (five neurogenic retentionists, two idiopathic overactive bladder) showed significant erectile improvement.
• Median IIEF-5 scores increased notably in responders, with sustained improvements at follow-up.

Conclusions:

• Sacral neuromodulation demonstrated a clinically significant benefit for sexual function, especially in neurogenic retention patients.
• Further research with larger cohorts exclusively focused on sexual dysfunction is warranted to elucidate SNM's mechanism of action.
• SNM may offer a therapeutic option for erectile dysfunction in specific patient populations.