Sacral neuromodulation

Abstract

Neuromodulation of the central nervous system (CNS) reexes that control lower urinary tract (LUT) function, using electrical stimulation of sacral nerves has become established as an effective treatment option for a range of LUT dysfunctions. The treatment has opened up a whole new field of surgical research and provides a much-needed new approach to treating LUT symptoms that are having a devastating effect on a person’s quality of life. Sacral nerve stimulation (SNS) offers patients with severe bladder overactivity and women with urinary retention the possibility of a substantial improvement in their urinary symptoms; other patient groups, such as those with bladder pain or neurogenic bladder dysfunction, may also be potential candidates for treatment. While the surgical procedures are minimally invasive, complications remain problematic. At least 30 % of patients will require unplanned reoperations for problems such as loss of clinical benefit, stimulator-associated pain and cable breakages. The expense of the hardware itself and the costs of follow up mean that there are unanswered questions regarding the cost-effectiveness of SNS. The treatment has the potential to be used in a large cohort of patients given the prevalence of the conditions being treated but cost-containment may lead to its use being restricted to patients with very severe symptoms.