Sacral Nerve Stimulation for Overactive Bladder and Voiding Dysfunction

Lower urinary tract problems as the overactive bladder, with or without urgency incontinence and nonobstructive voiding dysfunction, are often refractory to maximal conservative management. Sacral neuromodulation is an established treatment in these indications, with significant and sustained efficacy in non-neurogenic patients, and has an acceptable safety profile also in the long term. Adverse events such as lead migration and pain at the implantation site are in general transient and can be treated effectively. A rechargeable battery is available that reduces surgical interventions and can increase cost efficacy. The indication for sacral neuromodulation in patients with lower urinary storage problems has to be balanced against the possibility for onabotulinum toxinA injections in the bladder wall. Fecal incontinence is also an FDA-approved indication, and sacral neuromodulation can be applied for combined fecal and urinary urgency incontinence.