Neuromodulation in the Treatment of Voiding Dysfunction and Fecal Incontinence in Male and Female Cancer Survivors

Abstract

Sacral neuromodulation (SNM) is a widely accepted and minimally invasive treatment for several urologic lower urinary tract pathologies and bowel dysfunction. Treatment for pelvic malignancies is associated with significant rates of urinary, sexual, and fecal dysfunction. The authors sought to determine the role SNM should play in the management of voiding and fecal dysfunction in the male and female cancer survivor patient. There is a lack of studies looking at SNM in the cancer survivor population, particularly in the setting of radiation cystitis or proctitis. Regardless, the authors feel there is a role for SNM in this population. Further studies are needed to further delineate this role and the efficacy of SNM in this challenge to treat patient population. Voiding dysfunction in the cancer survivor population including urinary urgency, frequency, and urge incontinence is very common. Similarly, fecal incontinence occurs not infrequently and is a major source of patient distress. There is great evidence for SNM via InterStim in urinary urgency, urge incontinence, non-obstructive retention, and fecal incontinence. Studies are lacking, however, in the cancer survivor population. They are non-existent in the postradiation patient population. SNM is a good treatment option for urinary urgency, urge incontinence, non-obstructive urinary retention, and fecal incontinence. More studies are needed in the cancer survivor population, particularly following radiation therapy. Regardless, the authors feel there is a role in the cancer survivor for SNM.