Abstract
Objective: To review the evidence surrounding Sacral Neuromodulation therapy and delineate areas that will need more research. Methods: An extensive search was performed on the available literature on SNM for lower urinary tract dysfunction. Based on the results of the search, the mechanisms of action, indications, technique, and patient characteristics of therapy failures and success are presented and discussed. Results: SNM is accepted by the FDA since 1997 for the treatment of lower urinary tract dysfunction. As it is a relatively new procedure, there are variations in the technique of lead placement, generator choice, testing interval, patient selection, time to explantation, and definitions of therapy failures and successes. Conclusions: SNM is a safe and therapeutic option for the treatment of urgencyfrequency syndrome, urge incontinence, and idiopathic urinary retention. However, there are multiple unanswered questions that require extensive research.
Highlights
Sacral neuromodulation (SNM) received approval from the US Food and Drug Administration in 1997 for the treatment of urgency-frequency syndrome, refractory urge incontinence, and idiopathic urinary retention
Sacral neuromodulation (SNM) is FDA approved for urge incontinence, non-obstructive urinary retention and urinary urgency and frequency
Multiple factors are integral to the success of SNM therapy including but not limited to patient selection, surgical technique, patient compliance, insurance status, and surgeon preference
Summary
Sacral neuromodulation (SNM) received approval from the US Food and Drug Administration in 1997 for the treatment of urgency-frequency syndrome, refractory urge incontinence, and idiopathic urinary retention. It has become a valuable therapeutic option for patients that have failed anticholinergic therapy, behavioral modifications and pelvic floor rehabilitation. It is not clear what is the most efficient and cost effective approach to select patients for SNM. Length of time is balanced by potential for infection at the leads It is not clear how long the device will stay effective and if there is deterioration in function over time either due to reaction in leads or changes in generator. The purpose of this article is to review the evidence surrounding SNM therapy and delineate areas that need more research
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