Latest Technologic and Surgical Developments in Using InterStim™ Therapy for Sacral Neuromodulation: Impact on Treatment Success and Safety

Objectives: This article accompanies a "surgery in motion" DVD on sacral neuromodulation (SNM) with InterStim(TM) Therapy, which visualizes the implantation of the InterStim II system. The article describes the technical and surgical developments of SNM and their impact on treatment success, safety, and patient's quality of life (QoL). Methods: Relevant literature on SNM with regard to technical changes and related clinical outcomes has been reviewed. Results: Since its introduction in the early 1990s, SNM has proven useful in the treatment of several types of chronic urinary (and bowel) dysfunction. Recent technical improvements in devices and, in particular, the introduction of the tined lead 5 yr ago made SNM progress from an elaborate, open-surgery, general anesthesia, one-stage implant procedure to a minimally invasive, local anesthesia, percutaneous technique in two stages. The permanent tined lead implant enables a longer patient testing period (minimum of 14 d recommended) and less lead migration. This has considerably reduced technical failures and improved the success rate of the test phase; the response rate was almost doubled to approximately 80%. These improvements also affected tolerability, resulting in increased QoL for the patient. The use of the recently introduced smaller implantable neurostimulator InterStim II seems to further improve patient comfort and makes the implant procedure for the physician easier and shorter. However, this must be further addressed in clinical studies. Conclusions: SNM with InterStim Therapy using the tined lead offers an efficient treatment modality for patients in whom conservative treatment has failed. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.