Skip to main content

Advertisement

SpringerLink
Log in

Update on sacral neuromodulation: Indications and outcomes

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Tanagho and Schmidt first introduced sacral nerve neuromodulation in 1981. Since then, it has become increasingly popular and the indications for this procedure are growing. The purpose of this article is to discuss the established indications for sacral nerve stimulation (SNS). The outcomes of the most recent studies and trials dealing with SNS are presented. An overview of the most recent techniques used for neuromodulation is detailed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Schlote N, Tanagho EA: Electrical stimulation of the lower urinary tract: historical overview. In New Perspectives in Sacral Nerve Stimulation. Edited by Jonas U, Grunewald V. London: Martin Dunitz Ltd; 2002:1–8. This textbook discusses in detail different aspects of sacral neuromodulation. It includes chapters on predictive factors, diagnostic evaluations, surgical techniques, and results of clinical trials, among others. However, it only discusses various Medtronic InterStim therapies, with no references to other therapies.

    Google Scholar 

  2. Tanagho EA, Schmidt RA: Bladder pacemaker: scientific basis and clinical future. Urology 1982, 20:614–619.

    Article  PubMed  CAS  Google Scholar 

  3. Hassouna MM, Siegel SW, Nijeholt AA, et al.: Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. J Urol 2000, 163:1849–1854. This multicenter clinical study discusses the long-term (6 months) outcomes of patients using sacral neuromodulation for urgencyfrequency symptoms. These patients showed statistically significant outcomes compared with control subjects.

    Article  PubMed  CAS  Google Scholar 

  4. Scheepens WA, van Kerrebroeck PE: Indications and predictive factors. In New Perspectives in Sacral Nerve Stimulation. Edited by Jonas U, Grunewald V. London: Martin Dunitz Ltd; 2002:89–98.

    Google Scholar 

  5. Elabbady AA, Hassouna MM, Elhilali MM: Neural stimulation for chronic voiding dysfunctions. J Urol 1994, 152:2076–2080.

    PubMed  CAS  Google Scholar 

  6. Schmidt R: Advances in genitourinary neurostimulation. Neurosurgery 1986, 19:1041–1044.

    Article  PubMed  CAS  Google Scholar 

  7. Fowler CJ, Christmas TJ, Chapple CR, et al.: Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome? BMJ 1988, 297:1436–1438.

    Article  PubMed  CAS  Google Scholar 

  8. Swinn M, Kitchen N, Goodwin R, Fowler CJ: Sacral neuromodulation for women with Fowler’s syndrome. Eur Urol 2000, 38:439–443.

    Article  PubMed  CAS  Google Scholar 

  9. Shafik A: A new concept of the anatomy of the anal sphincter, mechanism and physiology of defecation: a review. In Advances in Coloproctology. Monduzzi: Bologna; 1986:719–742.

    Google Scholar 

  10. Matzel KE, Stadelmaier U, Hohenfellener M, Gall FP: Electrical stimulation of sacral spinal nerves for treatment of fecal incontinence. Lancet 1995, 346:1124–1127.

    Article  PubMed  CAS  Google Scholar 

  11. Vaizey CJ, Kamm MA, Nicholls RJ: Recent advances in the surgical treatment of fecal incontinence. Br J Surg 1998, 85:596–603.

    Article  PubMed  CAS  Google Scholar 

  12. Ripetti D, Caputo F, Ausania E, et al.: Sacral nerve neuromodulation improves physical, psychological and social quality of life in patients with fecal incontinence. Tech Coloproctol 2002, 6:147–152.

    Article  PubMed  CAS  Google Scholar 

  13. Ganio E, Masin A, Ratto C, et al.: Short-term sacral nerve stimulation for functional anorectal and urinary disturbances: results in 40 patients: evaluation of a new option for anorectal functional disorders. Dis Colon Rectum 2001, 44:1261–1267.

    Article  PubMed  CAS  Google Scholar 

  14. Vaizey CJ, Kamm MA, Roy AJ, et al.: Double-blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2000, 43:298–302.

    Article  PubMed  CAS  Google Scholar 

  15. Vaizey CJ, Kamm MA, Turner IC, et al.: Effects of short-term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut 1999, 44:407–412.

    Article  PubMed  CAS  Google Scholar 

  16. Malouf AJ, Vaizey CJ, Nicholls RJ, et al.: Permanent sacral nerve stimulation for fecal incontinence. Ann Surg 2000, 232:143–148.

    Article  PubMed  CAS  Google Scholar 

  17. Ganio E, Ratto C, Masin A, et al.: Neuromodulation for fecal incontinence: outcome in 16 patients with definitive implant. The initial Italian Sacral Neurostimulation Group (GINS) experience. Dis Colon Rectum 2001, 44:965–970.

    Article  PubMed  CAS  Google Scholar 

  18. Thon WF, Raskin LS, Jonas U, et al.: Neuromodulation of voiding dysfunction and pelvic pain. World J Urol 1991, 9:138–141.

    Google Scholar 

  19. Parsons CL: Interstitial cystitis. In Urogynecology and Urodynamics: Theory and Practice, edn 4. Edited by Ostergard DR, Bent AE. Baltimore: Williams & Wilkins; 1996:409.

    Google Scholar 

  20. Maher CF, Carey MP, Dwyer PL, et al.: Percutaneous sacral nerve root neuromodulation for intractable interstitial cystitis. J Urol 2001, 165:884–886.

    Article  PubMed  CAS  Google Scholar 

  21. Peters KM: Does sacral nerve modulation treat refractory interstitial cystitis? Proceedings of the First International Society of Pelvic Neuromodulation Conference. Ponte Vedra Beach, Florida: January 12–13, 2002.

  22. Chai TC, Zhang C, Warren JW, et al.: Percutaneous sacral third nerve root neurostimulation improves symptoms and normalizes urinary HB-EGF levels and antiproliferative activity in patients with interstitial cystitis. Urology 2000, 55:643–646.

    Article  PubMed  CAS  Google Scholar 

  23. Siegel S, Paszkiewicz E, Kirkpatrick C, et al.: Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol 2001, 166:1742–1745.

    Article  PubMed  CAS  Google Scholar 

  24. Pettit P, Thompson J, Chen A: Sacral neuromodulation: new applications in the treatment of female pelvic floor dysfunction. Curr Opin Obstet Gynecol 2002, 14:521–525. This article reviews indications for sacral neuromodulation and focuses on future applications.

    Article  PubMed  Google Scholar 

  25. Schmidt RA, Jonas U, Oleson RA, et al.: Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral Nerve Stimulation Study Group. J Urol 1999, 162:352–357.

    Article  PubMed  CAS  Google Scholar 

  26. Bosch JL, Groen J: Sacral nerve neuromodulation in the treatment of patients with refractory motor urge incontinence: long-term results of a prospective longitudinal study. J Urol 2000, 163:1219–1222.

    Article  PubMed  CAS  Google Scholar 

  27. Weil EH, Ruiz Cerd6 JL, Eerdmans PH, et al.: Sacral root neuromodulation in the treatment of refractory urinary urge incontinence: a prospective randomized clinical trial. Eur Urol 2000, 37:161–171.

    Article  PubMed  CAS  Google Scholar 

  28. Bemelmans BL, Mundy AR, Craggs MD: Neuromodulation by implant for treating lower urinary tract symptoms and dysfunction. Eur Urol 1999, 36:81–91.

    Article  PubMed  CAS  Google Scholar 

  29. Bosch JL, Groen J: Sacral (S3) segmental nerve stimulation as a treatment for urge incontinence in patients with detrusor instability: results of chronic electrical stimulation using an implantable neural prosthesis. J Urol 1995, 154:504–507.

    Article  PubMed  CAS  Google Scholar 

  30. Bosch JL, Groen J: Neuromodulation: urodynamic effects of sacral (S3) spinal nerve stimulation in patients with detrusor instability or detrusor hypeflexia. Behav Brain Res 1998, 92:141–150.

    Article  PubMed  CAS  Google Scholar 

  31. Braun PM, Boschert, Bross S, et al.: Tailored laminectomy: a new technique for neuromodulator implantation. J Urol 1999, 162:1607–1609.

    Article  PubMed  CAS  Google Scholar 

  32. Ishigooka M, Zermann DH, Doggweiler R, Schmidt RA: Sacral nerve stimulation and diurnal urine volume. Eur Urol 1999, 36:421–426.

    Article  PubMed  CAS  Google Scholar 

  33. Bosch JL, Groen J: Treatment of refractory urge urinary incontinence with sacral spinal nerve stimulation in multiple sclerosis patients. Lancet 1996, 348:717–719.

    Article  Google Scholar 

  34. Shaker H, Hassouna MM: Sacral root neuromodulation in the treatment of various voiding and storage problems. Int Urogynecol Pelvic Floor Dysfunct 1999, 10:336–343.

    Article  CAS  Google Scholar 

  35. Tanagho EA: Prinzipien und indikationen der elektrostimulation der harnblase. Urologe 1990, 29:185–190.

    PubMed  CAS  Google Scholar 

  36. Weil EH, Ruiz Cerda AL, Eerdmans PH, et al.: Clinical results of sacral neuromodulation for chronic voiding dysfunction using unilateral sacral foramen electrodes. World J Urol 1998, 16:313–321.

    Article  PubMed  CAS  Google Scholar 

  37. Hassouna MM, Group NS: Effect of sacral neuromodulation on urinary urgency-frequency. J Urol 1999, 162:254.

    Article  Google Scholar 

  38. Hasan ST, Neal DE: Neuromodulation in bladder dysfunction. Curr Opin Obstet Gynecol 1998, 10:395–399.

    Article  PubMed  CAS  Google Scholar 

  39. Bower WF, Moore KH, Adams RD, Shepherd R: A urodynamic study of surface neuromodulation versus sham in detrusor instability and sensory urgency. J Urol 1998, 160:2133–2136.

    Article  PubMed  CAS  Google Scholar 

  40. Walsh IK, Johnston RS, Keane PE: Transcutaneous sacral neurostimulation for irritative voiding dysfunction. Eur Urol 1999, 35:192–196.

    Article  PubMed  CAS  Google Scholar 

  41. Aboseif S, Tamaddon K, Chalfin S, et al.: Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction. Urology 2002, 60:52–56.

    Article  PubMed  Google Scholar 

  42. Aboseif S, Tamaddon K, Chalfin S, et al.: Sacral neuromodulation in functional urinary retention: an effective way to restore voiding. BJU Int 2002, 90:662–665.

    Article  PubMed  CAS  Google Scholar 

  43. Spinelli M, Giardiello G, Arduini A, van den Hombergh U: New percutaneous technique of sacral nerve stimulation has high initial success rate: preliminary results. Eur Urol 2003, 43:70–74. This is the first clinical trial to look at the new percutaneous technique of sacral nerve stimulation. Its preliminary results are promising.

    Article  PubMed  Google Scholar 

  44. Ingersoll EH, Jones LL, Hegre ES: Effect on urinary bladder of unilateral stimulation of pelvic nerves in the dog. Am J Physiol 1957, 189:167.

    PubMed  CAS  Google Scholar 

  45. de Groat WC: Anatomy and physiology of the lower urinary tract. Urol Clin North Am 1993, 20:383–401.

    PubMed  Google Scholar 

  46. Scheepens WA, de Bie RA, Weil E, van Kerrebroeck PE: Unilateral versus bilateral sacral neuromodulation in patients with chronic voiding dysfunction. J Urol 2002, 168:2046–2050. For the first time, a study comparing bilateral and unilateral sacral nerve stimulation was performed. This study and others to follow will help to establish the indications for bilateral stimulation.

    Article  PubMed  CAS  Google Scholar 

  47. Jezernik S, Craggs M, Grill WM, et al.: Electrical stimulation for the treatment of bladder dysfunction: current status and future possibilities. Neurol Res 2002, 24:413–430. This interesting article discusses various external and implantable devices used in neurostimulation, with a detailed look at the Finetech-Brindley stimulator. It also summarizes some recent research efforts.

    Article  PubMed  Google Scholar 

  48. Egon G, Barat M, Colombel P, et al.: Implantation of anterior sacral root stimulators combined with posterior sacral rhizotomy in spinal injury patients. World J Urol 1998, 16:342–349.

    Article  PubMed  CAS  Google Scholar 

  49. Vodusøek DB, Light KJ, Libby JM: Detrusor inhibition induced by stimulation of pudendal nerve afferents. Neurourol Urodyn 1986, 5:381–385.

    Article  Google Scholar 

  50. Gerber M, Swoyer J, Tronnes C: Hardware: development and function. In New Perspectives in Sacral Nerve Stimulation. Edited by Jonas U, Grunewald V. London: Martin Dunitz Ltd; 2002:81–88.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Toronto Western Hospital, MP 8-306, 399 Bathurst Street, M5T-2S8, Toronto, ON, Canada

    Magdy Hassouna MD, N. Elmayergi MD & M. Abdelhady MD

Authors
  1. Magdy Hassouna MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Elmayergi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Abdelhady MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hassouna, M., Elmayergi, N. & Abdelhady, M. Update on sacral neuromodulation: Indications and outcomes. Curr Urol Rep 4, 391–398 (2003). https://doi.org/10.1007/s11934-003-0014-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-003-0014-2

Keywords

Search

Navigation