Which Patients With Dysfunctional Voiding Respond Well to Sacral Neuromodulation? ICI-RS 2025

Area of Science:

• Urology
• Neuroscience
• Medical Research

Background:

• Dysfunctional voiding (DV) presents with variable urinary flow in neurologically normal individuals.
• Heterogeneous pathophysiology and differing definitions complicate sacral neuromodulation/sacral nerve stimulation (SNM/SNS) outcome reporting for DV.
• Accurate prediction of SNM/SNS response in DV requires further research into patient selection.

Purpose of the Study:

• To identify research areas for accurately predicting SNM/SNS response in adult DV patients.
• To improve patient stratification for SNM/SNS therapy in dysfunctional voiding.

Main Methods:

• Literature review by a multidisciplinary panel.
• Discussion and synthesis of findings at the ICI-RS meeting (2025, UK).

Main Results:

• DV diagnosis relies on pressure-flow studies and uroflowmetry; further tests aid pathophysiology understanding.
• Phenotyping lower urinary tract dysfunction may reveal patient subgroups with better SNM/SNS response (e.g., Fowler's syndrome).
• Older age, weight changes, and neuropsychiatric comorbidities show mixed associations with SNM/SNS outcomes, potentially impacting DV treatment.

Conclusions:

• Precise phenotyping integrating clinical, urodynamic, neurophysiological, and neuropsychiatric factors is crucial for predicting SNM/SNS response in DV.
• Future research must establish clear patient selection criteria and conduct prospective studies to evaluate SNM/SNS efficacy and complications in DV.