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An overview of sacral neuromodulation: a treatment for patients with symptoms of lower urinary tract dysfunction

13 August 2020
Focus
02 August 2020
Volume 29 · Issue 15

Abstract

This article provides an introduction to patient selection for, and the processes involved in, sacral neuromodulation (SNM) device implantation as a treatment for urinary symptoms. SNM has been an option to treat lower urinary tract dysfunction for more than 20 years and is a treatment for both overactive bladder syndrome (OAB) and female non–obstructed chronic urinary retention (FCUR). It is recognised by the National Institute for Health and Care Excellence as a therapeutic option for OAB and FCUR. SNM has its place in the pathway for the treatment of both conditions and, in the correctly assessed patient, can be the last option before considering major surgical intervention.

Electrical stimulation of the sacral nerves as a treatment for the symptoms of lower urinary tract dysfunction (LUTD) dates back to the mid-1990s, when sacral nerve stimulation (SNS), an alternative term for sacral neuromodulation (SNM), received approval from the US Food and Drug Administration (Marcelissen et al, 2011).

The work of Tanagho and Schmidt (1982) first demonstrated the therapeutic potential of SNS in the early 1980s (Van Kerrebroeck and Marcelissen, 2012). During the past two decades, SNS has been adapted and refined, both in terms of the implantation techniques and the device electronics. SNM leads are now implanted percutaneously and some devices are both safe during magnetic resonance imaging (MRI) and rechargeable.

SNM can be used to treat two LUTD conditions: overactive bladder (OAB) syndrome and female non-obstructive chronic urinary retention (FCUR) (National Institute for Health and Care Excellence (NICE), 2015; Liberman et al, 2017; NICE, 2019).

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Sacral neuromodulation
Sacral nerve stimulation
Urinary incontinence
Lower urinary tract dysfunction
Overactive bladder
Fowler's syndrome
Female non-obstructed chronic urinary retention