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Neuromodulation in the Older Woman: An Advanced Treatment Option for Urgency Urinary Incontinence

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Abstract

Purpose of Review

Urgency urinary incontinence (UUI) disproportionately impacts older women, and treatment strategies should minimize known harms while optimizing benefits. In the present review, we seek to provide an overview of the recent literature as it relates to neuromodulation and the treatment of older women with UUI. We also highlight recent innovations to neuromodulation therapy which have the potential to significantly improve access to neuromodulation for older women, in addition to improvements in longevity and cost-effectiveness.

Recent Findings

With respect to sacral neuromodulation (SNM) in older women, a randomized trial of women with non-neurogenic UUI found that older women undergoing SNM did not experience differential incontinence outcomes compared with younger women. In a separate retrospective cohort study, higher decade of age was found to be associated with lower odds of implantation and higher addition of therapies post-implantation. The development of a new MRI-compatible SNM lead has increased the number of eligible patients for SNM and the increased longevity of the new pulse generator will decrease the need for repeat surgery for generator replacements. With respect to posterior tibial nerve stimulation (PTNS), a significant barrier to access is currently the requirement for in-office visits for treatment. Newer implantable posterior tibial nerve electrodes have shown promising short-term efficacy and would provide a way for home-based remote PTNS obviating previous transportation-based barriers.

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Authors and Affiliations

  1. Division of Urogynecology, Department of Obstetrics & Gynecology, Rush University Medical Center, 1653 W Congress Parkway Kellogg 231, 60612, Chicago, IL, USA

    Michele O’Shea

  2. Division of Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Duke University Health System, Durham, NC, USA

    Cindy L Amundsen

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Correspondence to Michele O’Shea.

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Conflict of Interest Statement

Michele O’Shea has received consulting fees from GE Women’s Health Ultrasound Cindy L. Amundsen receives research grants from BlueWind Medical.

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All reported studies/experiments with human or animal subjects performed by the authors were performed in accordance with all applicable ethical standards including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines.

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O’Shea, M., Amundsen, C.L. Neuromodulation in the Older Woman: An Advanced Treatment Option for Urgency Urinary Incontinence. Curr Geri Rep 12, 7–12 (2023). https://doi.org/10.1007/s13670-023-00379-3

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  • DOI: https://doi.org/10.1007/s13670-023-00379-3

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