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How does sacral modulation work best? Placement and programming techniques to maximize efficacy.

Bastian Amend1, Mahmoud Khalil, Thomas M Kessler

  • 1Department of Urology, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.

Current Urology Reports
|June 29, 2011
PubMed
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Sacral neuromodulation (SNM) is a key treatment for incontinence and retention. Technical advancements and staged implantation optimize SNM efficacy and patient response rates for various conditions.

Area of Science:

  • Urology
  • Neuromodulation
  • Medical Device Technology

Background:

  • Sacral neuromodulation (SNM) received FDA approval in 1997.
  • SNM is a recommended treatment for urinary urge incontinence, urgency-frequency, nonobstructive urinary retention, and fecal incontinence.
  • Technical modifications and technique innovations have been introduced by manufacturers, surgeons, and researchers.

Purpose of the Study:

  • To review current knowledge and recommendations for SNM.
  • To cover preoperative decision-making, implantation techniques, and programming parameters.
  • To provide an evidence-based approach for optimizing SNM.

Main Methods:

  • MEDLINE research.
  • Review of manufacturer instructions.

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  • Incorporation of an experienced neurourological team's approach.
  • Main Results:

    • Key technical advancements include the tined-lead electrode and InterStim II impulse generator.
    • A staged implantation technique allows for sequential evaluation and definitive implantation.
    • This algorithm enhances the responder rate for all SNM indications.

    Conclusions:

    • Optimized SNM techniques and algorithms improve treatment efficacy.
    • The combination of advanced hardware and staged implantation increases patient response rates.
    • SNM remains a vital therapeutic option for multiple lower urinary and fecal dysfunction conditions.