Abstract
ABSTRACTPurpose To review current literature regarding sacral neuromodulation (SNM) for neurogenic lower urinary tract dysfunction (NLUTD) focused on indications, barriers and latest technological developments.Material and Methods A PubMed database search was performed in April 2020, focusing on SNM and various neuro-urological conditions.Results SNM has been increasingly indicated for lower urinary tract dysfunction (LUTD) in neuro-urological patients. Most studies are cases series with several methodological limitations and limited follow-up, lacking standardized definition for SNM clinical success. Most series focused on neurogenic overactive bladder in spinal cord injured (incomplete lesions) and multiple sclerosis patients. Barriers for applying this therapy in neurogenic LUTD were mainly related to magnetic resonance imaging incompatibility, size of the implantable pulse generator (IPG), and battery depletion. Newer technological advances have been made to address these limitations and will be widely available in the near future.Conclusions SNM seems a promising therapy for neurogenic LUTD in carefully selected patients with incomplete lesions. Further studies are still needed to define which subgroups of neurological patients benefit the most from this minimally invasive technique.
Highlights
Sacral neuromodulation (SNM) is an established third-line treatment for idiopathic lower urinary tract dysfunctions (LUTD) in patients who failed conservative therapies, such as behavioral and pharmacological strategies
A PubMed database search was conducted in April 2020 using the following Medical Subject Heading (MeSH) terms: ‘sacral neuromodulation’ and either ‘neurogenic’ or ‘spinal cord’ or ‘multiple sclerosis’ or ‘Parkinson’ or ‘cerebrovascular accident’ or ‘spinal bifida’ or ‘disk surgery’
sacral neuromodulation (SNM) has been used in different neurological diseases, such as incomplete sacral cord injury (SCI), multiple sclerosis (MS), Parkinsons disease (PD), cerebrovascular accident (CVA), cerebral palsy (CP), and brain trauma (Level of Evidence: III, Grade of Recommendation: C) [5]
Summary
Sacral neuromodulation (SNM) is an established third-line treatment for idiopathic lower urinary tract dysfunctions (LUTD) in patients who failed conservative therapies, such as behavioral and pharmacological strategies. Since SNM influences sacral afferents and modulates spinal cord reflexes and brain centers which control the lower urinary tract (LUT), this therapy is usually indicated for patients whose neural system is intact or is partially damaged. Most studies on SNM focused on the role of this minimally invasive treatment in patients presenting idiopathic overactive bladder (iOAB), chronic non-obstructive urinary retention and chronic pelvic pain. Neurogenic Overactive Bladder (nOAB) is characterized by ‘urgency, with or without urgency urinary incontinence, usually with increased daytime frequency and nocturia in the setting of a clinically relevant neurologic disorder with at least partially preserved sensation’ [4]. This article aims to review the available evidence on SNM for patients with distinct neurological diseases, highlighting current barriers and latest technological developments, which may impact the urological practice
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