Improving Sacral Neuromodulation for Lower Urinary Tract and Bowel Dysfunction: A Translational and Multidisciplinary Approach

Lower urinary tract and bowel dysfunction are associated with a decreased control of micturition and/or defecation. Sacral neuromodulation (SNM), using electrical stimulation of a nerve root in the lower back, is a treatment for these disorders and provides patients a better quality of life. In this thesis, two animal models, one for faecal incontinence and one for lower urinary tract dysfunction, were further optimized. These optimized models now allow future studies to investigate and improve interventions for lower urinary tract and bowel dysfunction, such as SNM. In addition, this thesis provides a systematic overview of the recent developments in the use and efficacy of SNM stimulation parameters in clinical and animal studies and revealed that the therapeutic effect of SNM can be improved by adjusting relevant stimulation parameters. Lastly, this thesis showed that a new form of SNM, called Burst-SNM, can modulate bladder and urethral responses in a distinctive way as compared to standard SNM stimulation parameters. These findings provide a new perspective to further optimize clinical outcome.