[Sacral neuromodulation in under- and overactive detrusor-quo vadis? : Principles and developments]

Area of Science:

• Neurology
• Urology
• Gastroenterology

Background:

• Sacral neuromodulation (SNM) has been a treatment for refractory overactive bladder syndrome, nonobstructive urinary retention, and fecal incontinence for nearly 40 years.
• It is distinct from sacral anterior root stimulation, which is used for bladder dysfunction in spinal paraplegia.

Purpose of the Study:

• To review the principles, techniques, outcomes, and contraindications of sacral neuromodulation.
• To discuss the potential expansion of SNM indications.

Main Methods:

• SNM involves modulating afferent neurons influencing micturition.
• The implantation is a two-stage procedure with an initial trial phase.
• Regular check-ups and wireless adjustments ensure long-term symptom management.

Main Results:

• SNM suppresses premature detrusor contractions, delays the urge to void, and improves detrusor-sphincter coordination.
• Success rates for overactive bladder syndrome and urinary retention exceed 70%, sustained for at least 5 years.
• SNM is also effective for fecal incontinence and chronic constipation.

Conclusions:

• SNM is a well-established therapy with proven efficacy and long-term benefits.
• Potential future indications include chronic pelvic pain syndrome, erectile dysfunction, and additional gastrointestinal conditions.
• Technological advancements are expected to further enhance the risk-benefit profile of SNM.