Should We Consider Sacral Nerve Stimulation as a Treatment for Neurogenic Lower Urinary Tract Dysfunction? ICI-RS 2025

Aims To explore the boundary of clinical use of sacral nerve stimulation (SNS) in neurogenic lower urinary tract dysfunction (NLUTD), identifying barriers to approval and early-impact research questions.Methods This review is derived from a proposal discussion at the International Consultation on Incontinence-Research Society in Bristol in June 2025.Results Current evidence for predicting NLUTD symptom improvement or functional recovery after SNS remains mainly from small retrospective cohorts. Definitive trials are a research priority, accordingly. The influence of SNS on urodynamic parameters is uncertain due to the lack of studies with urodynamics as the primary endpoint. Additionally, there is no core outcome set for NLUTD treated with SNS. Use of closed-loop SNS in NLUTD to adjust stimulation parameters may improve outcome and device longevity. Hence, we need to elucidate how SNS modulates LUT control network over time and across disease stages. Optimal stimulation parameters need to be defined for patient populations, but also for individuals, with dynamic strategies for adjustment. Use of SNS in NLUTD needs to enable ongoing use of MRI scanning for neurological evaluation, especially in progressive conditions. An MR Conditional SNS device means it can be safely scanned in specific MR environments. Use of such a device needs to factor in the range of further electronic implants that might be used in complex medical conditions.Conclusions The application of SNS to NLUTD is likely to increase. A key aspiration is nuanced patient selection, using functional assessment and urodynamic findings. To translate SNS into standard clinical practice, interdisciplinary collaboration and robust clinical trials are essential.