Sacral neuromodulation for urinary incontinence

Sacral neuromodulation (SNM) was first approved in Europe in 1994 and the United States in 1997. Since its initial approval, indications for SNM have expanded to include urinary urgency/frequency, urgency urinary incontinence (UUI), non-obstructive urinary retention, and fecal incontinence. In the realm of idiopathic overactive bladder (OAB) and UUI multiple studies have highlighted the effectiveness of this therapy with the most recent data reporting a success rate of 93% at 2 year follow-up. Additionally, SNM has been compared to various other therapies for OAB/UUI. SNM demonstrated superiority in terms of symptom improvement when compared to anticholinergic medication and similar efficacy to 200 units of intradetrusor onabotulinum toxin. SNM has also demonstrated similar effectiveness in management of neurogenic patients although there remains a paucity of high level data in these patients. With the introduction of systems with improved MRI conditionality ongoing studies aim to evaluate effectiveness within this population.