Dr. Dean S. Elterman, MD, MSc, FRCSC,1 Harkiran K. Sagoo, BSc(Hons),2

1Attending Urologic Surgeon, Toronto Western Hospital, University Health Network, Assistant Professor, Division of Urology, Department of Surgery, University of Toronto, Toronto, ON.
24th Year Medical Student at GKT School of Medicine, King's College London, U.K.


Abstract: Sacral Neuromodulation (SNM) is a FDA-approved minimally invasive surgical therapy offered as a third-line treatment for refractory overactive bladder (OAB). Studies report improvements in continence, mean number of voids/day, quality of life, depression and sexual function in patients receiving SNM compared to medical therapy, with treatment success sustained long-term and with few adverse events. SNM is recommended by CUA and AUA guidelines in the treatment of OAB in carefully selected patients.
Key Words:Neuromodulation, Neurostimulation, Overactive, Bladder, Incontinence.

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Sacral neuromodulation should be offered as third-line treatment for patients with overactive bladder symptoms refractory to conservative/behavioural and/or pharmacological treatment.
Sacral neuromodulation is a minimally invasive procedure that may be offered to carefully selected patients with severe refractory overactive bladder that are willing to undergo a surgical procedure.
Sacral neuromodulation activates inhibitory sympathetic neurons using low-amplitude electrical stimulation of S3 afferent nerve roots to prevent detrusor contraction.
A prospective, randomized multi-center trial (level 1 evidence) reported improvements in incontinence, mean number of voids/day, quality of life, depression and sexual function in patients receiving sacral neuromodulation compared to standard medical treatment.
Adverse events/complications associated with SNM use include: pain at the implantation site, lead migration, wound-related complications, bowel dysfunction, infection, and generator problems.
Sacral neuromodulation is a FDA-approved minimally-invasive surgical therapy used as third-line treatment of overactive bladder symptoms/refractory overactive bladder. It is carried out in two stages, the first (evaluation) stage involves insertion of a temporary generator to assess clinical efficacy, and the second stage involves insertion of a permanent neuromodulator implant in patients that have demonstrated >50% improvement in symptoms during the evaluation stage.
Evidence from randomized, controlled trials, prospective multicenter, prospective single-center and retrospective studies demonstrates clinical efficacy of SNM in reducing symptoms of overactive bladder in these patients and therefore SNM is recommended by CUA and AUA guidelines in the treatment of overactive bladder in carefully-selected patients, as the risks of the procedure outweigh the burdens of the overactive bladder syndrome.
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