Sacral Neuromodulation

Abstract

Millions of men and women throughout the world are bothered by urinary incontinence and voiding dysfunction. After initial therapies have failed such as anticholinergics, other treatment options such as sacral neuromodulation (SNM) should be considered in appropriate patients. Bladder overactivity and voiding dysfunction are likely the result of an imbalance of the reflexes between the bladder, pelvic floor, and urethral sphincter. SNM appears to restore this balance that is needed for normal voiding function. Sacral neuromodulation, commercially marketed as InterStim™, is approved by the US Food and Drug Administration (FDA) for treatment of urinary urge incontinence, urinary urgency, urinary frequency, non-obstructive urinary retention, and fecal incontinence. InterStim is first trialed in appropriate patients using either an office based percutaneous nerve evaluation or as a staged outpatient procedure in the operating room and involves placing a lead along the S3 nerve. Percutaneous tibial nerve stimulation (PTNS) is another form of neuromodulation that is achieved by accessing the posterior tibial nerve above the ankle sending stimulation to the sacral plexus (S2–S4) modulating bladder innervation. Urgent PC is an FDA approved neuromodulation system providing this retrograde stimulation as an office based therapy. This chapter describes indications for use, patient evaluation, surgical techniques, and outcomes for sacral neuromodulation and PTNS.