Sacral Neuromodulation in Non-Neurogenic Lower Urinary Tract Symptoms: Clinical Efficacy and Safety

The aim of this study is to evaluate the effectiveness of sacral neuromodulation (SNM) on clinical symptoms, lower urinary tract function, and objective measurements in patients diagnosed with overactive bladder (OAB) and chronic nonobstructive urinary retention (CNOUR), and to identify factors affecting treatment response.

This multicenter retrospective chart review included patients diagnosed with OAB and CNOUR who underwent SNM between 2015 and 2025 at four tertiary referral centers. All patients underwent a standard two-stage SNM protocol. Clinical evaluation was performed at the first and third postoperative months after stage II implantation using urinary incontinence status, clean intermittent catheterization (CIC) requirement, bladder diary data, and uroflowmetric parameters. Demographic and technical factors affecting success were analyzed.

A total of 160 patients were included in the study. Of these patients, 113 (70.6%) were female, and the mean age was 41 years. SNM was performed for OAB in 63 patients (39.4%) and for CNOUR in 97 patients (60.6%). After the first stage of SNM, clinical success was achieved in 50 patients (79.4%) in the OAB group and 68 patients (70.1%) in the CNOUR group. In the CNOUR group, the need for CIC completely disappeared in 38.2% of patients after SNM, while the frequency of catheterization decreased by at least 50% in 22.1% of patients. Urinary incontinence completely resolved in 52% of the OAB group and 69.1% of the CNOUR group. In uroflowmetric evaluation, Qmax and PVR improved significantly in the CNOUR group, whereas voided volume was used as a supportive parameter for interpreting Qmax. A higher number of contacts receiving stimulation during the first stage was significantly associated with treatment success. No serious perioperative complications were observed.

Sacral neuromodulation is an effective and safe treatment option for patients with overactive bladder and chronic urinary retention. Its ability to reduce the need for catheterization and improve voiding function is of great clinical importance, especially in patients with chronic urinary retention. The success of SNM can be increased with appropriate patient selection, careful evaluation during the testing phase, and optimal technical application.