Neuromodulation—Sacral, Peripheral and Central: Current Status, Indications, Results and New Developments

Abstract

This article provides basic information on the current status in sacral, peripheral and central neuromodulation techniques. Sacral neuromodulation has been a well-established method for treatment of urinary dysfunction for over 15 years. While it has proved itself to be a long-term successful method of treatment for patients with neurogenic or non-neurogenic overactive bladder (OAB) or chronic retention, many patients are excluded from this beneficial therapy form, as the peripheral nerve evaluation (PNE) test carried out prior to implantation of a permanent neuromodulator still produces non-responder rates of 50% or more. The new two-stage approach developed by Spinelli et al. gives rise to the hope that some problems connected to the PNE test can be overcome through use of the final electrodes during the test. The bion technique, moreover, a brand new technological development for peripheral neuromodulation, may produce new and interesting results in the future. Finally, research is under way for a third neuromodulation approach of direct stimulation in the pontine micturition center, as investigations in Parkinson patients have shown that the incontinence situation can be improved significantly by activation of the deep brain stimulator.