Neuromodulation for Non-obstructive Urinary Retention

Abstract

Non-obstructive urinary retention in children and adults is distinct from classical urinary retention in that no anatomic cause for incomplete bladder emptying can be found. This poses unique challenges to treating clinicians, and until recently, management was limited to physical therapy, assisted emptying with intermittent catheterization, foley catheter placement, or urinary diversion. Neuromodulation, in multiple forms, offers a minimally invasive method to restore normal urinary function in some patients suffering from non-obstructive urinary retention. The techniques and evidence for this will be discussed. Sacral neuromodulation has garnered the most attention in the literature, but other forms of neuromodulation such as posterior tibial nerve stimulation, nerve re-routing, sacral anterior nerve stimulation, and emerging technologies incorporating biologic feedback also exist and show promise. The next decade promises more improvements for the treatment of non-obstructive urinary retention emphasizing the ability to void spontaneously. Neuromodulation techniques over the next decade may make it possible to reduce or eliminate the need for catheters and urinary diversion in these patients.