Optimizing Neuromodulation Testing—Who, When, and How?

Abstract

We review the current literature pertaining to recommendations for selecting appropriate patients and performing a test phase for sacral neuromodulation. Current literature reveals that this therapy can be successfully offered to patients with mild and severe forms of refractory overactive bladder, wet or dry. It can also be offered to elderly patients and patients with concurrent fecal incontinence, even in the setting of a known history of obstetric anal sphincter injury. Patients with non-obstructive urinary retention should be carefully selected with other etiologies ruled out, and an emphasis on those patients with suspected Fowler’s syndrome. We also summarize the recommendations for ideal lead placement and the advantages/disadvantages of a percutaneous nerve evaluation in the office compared to a staged procedure. The use of sacral neuromodulation for bladder dysfunction has evolved over the years. Patient selection and testing technique is an important component in optimizing the success of this therapy.