Use of sacral neuromodulation in the treatment of overactive bladder syndrome
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20250067Keywords:
Sacral neuromodulation, Overactive bladder syndrome, Neuromodulation therapy, Urinary incontinence, Pelvic disordersAbstract
Overactive bladder syndrome (OAB) is a prevalent condition characterized by urinary urgency, frequency, and incontinence, significantly impacting patients’ quality of life. Sacral neuromodulation (SNM) has emerged as an effective treatment, particularly for individuals unresponsive to conventional therapies. SNM operates by modulating sacral nerve activity to restore normal bladder function, offering both symptom relief and enhanced quality of life. Recent clinical studies demonstrate its long-term efficacy, with sustained improvements in urgency and frequency, and high patient satisfaction rates. Mechanisms underlying SNM involve the modulation of peripheral and central nervous pathways, normalizing overactive detrusor activity and rebalancing excitatory and inhibitory neural signals. Advances in device technology, including rechargeable systems and adaptive stimulation, have further optimized its clinical utility. Minimally invasive techniques and improved electrode designs have enhanced the safety and accessibility of SNM, reducing complications and recovery times. Emerging applications of SNM extend beyond OAB, showing potential in managing neurogenic bladder, fecal incontinence, and chronic pelvic pain. Integration with digital health technologies allows for remote monitoring and personalized adjustments, improving patient outcomes and adherence. Future directions include exploring combined therapies, expanding indications, and leveraging machine learning for tailored neuromodulation. As innovations continue to refine SNM, its role in treating complex pelvic disorders is set to expand, offering a durable, effective solution for patients with refractory conditions. This evolution highlights SNM’s transformative potential in both urological and multidisciplinary care.
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References
Chartier-Kastler E. Sacral neuromodulation for treating the symptoms of overactive bladder syndrome and non-obstructive urinary retention: >10 years of clinical experience. BJU Int. 2008;101(4):417. DOI: https://doi.org/10.1111/j.1464-410X.2007.07233.x
Blok BF. Sacral neuromodulation for the treatment of urinary bladder dysfunction: mechanism of action and future directions. Bioelectr Med. 2018;1(1):85-94. DOI: https://doi.org/10.2217/bem-2017-0003
Bartley J, Gilleran J, Peters K. Neuromodulation for overactive bladder. Nature Rev Urol. 2013;10(9):513-21. DOI: https://doi.org/10.1038/nrurol.2013.143
Sukhu T, Kennelly MJ, Kurpad R. Sacral neuromodulation in overactive bladder: a review and current perspectives. Res Rep Urol. 2016;193-9. DOI: https://doi.org/10.2147/RRU.S89544
Tilborghs S, De Wachter S. Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects. Expert Rev Med Dev. 2022;19(2):161-87. DOI: https://doi.org/10.1080/17434440.2022.2032655
Laviana A, Jellison F, Kim J-H. Sacral neuromodulation for refractory overactive bladder, interstitial cystitis, and painful bladder syndrome. Neurosurg Clin. 2014;25(1):33-46. DOI: https://doi.org/10.1016/j.nec.2013.08.001
Elkelini MS, Abuzgaya A, Hassouna MM. Mechanisms of action of sacral neuromodulation. Int Urogynecol J. 2010;21:439-46. DOI: https://doi.org/10.1007/s00192-010-1273-3
Panicker JN. Neurogenic bladder: epidemiology, diagnosis, and management. Paper presented at: Seminars in neurology. 2020. DOI: https://doi.org/10.1055/s-0040-1713876
Perez NE, Godbole NP, Amin K, Syan R, Gater Jr DR. Neurogenic bladder physiology, pathogenesis, and management after spinal cord injury. J Personalized Med. 2022;12(6):968. DOI: https://doi.org/10.3390/jpm12060968
Gill BC, Pizarro-Berdichevsky J, Bhattacharyya PK, Thaddeus SB, Brian KM, Adrienne Q, et al. Real-time changes in brain activity during sacral neuromodulation for overactive bladder. J Urol. 2017;198(6):1379-85. DOI: https://doi.org/10.1016/j.juro.2017.06.074
Janssen PT, Komen N, Melenhorst J, Nicole DB, Ali J, Yasin T, et al. Sacral neuromodulation for fecal incontinence: a review of the central mechanisms of action. J Clin Gastroenterol. 2017;51(8):669-76. DOI: https://doi.org/10.1097/MCG.0000000000000850
White WM, Mobley III JD, Doggweiler R, Dobmeyer-Dittrich C, Klein FA. Incidence and predictors of complications with sacral neuromodulation. Urology. 2009;73(4):731-5. DOI: https://doi.org/10.1016/j.urology.2008.11.047
Blok B, Van Kerrebroeck P, de Wachter S, et al. Two‐year safety and efficacy outcomes for the treatment of overactive bladder using a long‐lived rechargeable sacral neuromodulation system. Neurourol Urodynamics. 2020;39(4):1108-14. DOI: https://doi.org/10.1002/nau.24317
Siegel S, Noblett K, Mangel J, Jason B, Tomas LG, Suzette ES, et al. Five-year followup results of a prospective, multicenter study of patients with overactive bladder treated with sacral neuromodulation. J Urol. 2018;199(1):229-36. DOI: https://doi.org/10.1016/j.juro.2017.07.010
Huang J, Fan Y, Zhao K, Chunlan Y, Ziqi Z, Yin C, et al. Comparative efficacy of neuromodulation technologies for overactive bladder in adults: a network meta-analysis of randomized controlled trials. Neuromodulation: Technol Neural Interface. 2023;26(8):1535-48. DOI: https://doi.org/10.1016/j.neurom.2022.06.004
Wang Z-H, Liu Z-H. Treatment for overactive bladder: A meta-analysis of tibial versus parasacral neuromodulation. Medicine. 2022;101(41):e31165. DOI: https://doi.org/10.1097/MD.0000000000031165
Tahseen S. Role of sacral neuromodulation in modern urogynaecology practice: a review of recent literature. Int Urogynecol J. 2018;29:1081-91. DOI: https://doi.org/10.1007/s00192-017-3546-6
Smits MA, Oerlemans D, Marcelissen TA, Van Kerrebroeck PE, De Wachter SG. Sacral neuromodulation in patients with idiopathic overactive bladder after initial botulinum toxin therapy. J Urol. 2013;190(6):2148-52. DOI: https://doi.org/10.1016/j.juro.2013.07.017
Li Z-J, Zhang L-B, Chen Y-X, Hu L. Advancements and challenges in neuromodulation technology: interdisciplinary opportunities and collaborative endeavors. Sci Bull. 2023;68(18):1978-82. DOI: https://doi.org/10.1016/j.scib.2023.08.019
Yaiesh SM, Al-Terki A, Al-Shaiji TF. Neuromodulation in urology: Current trends and future applications. In: Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice. IntechOpen, 2020.
Marinkovic SP. New technologies in the management of overactive bladder: current research and future prospects. Therapeutic Adv Urol. 2019;11:1756287219844669. DOI: https://doi.org/10.1177/1756287219844669
Abello A, Das AK. Electrical neuromodulation in the management of lower urinary tract dysfunction: evidence, experience and future prospects. Therapeutic Adv Urol. 2018;10(5):165-73. DOI: https://doi.org/10.1177/1756287218756082
Suskind AM, Dunn RL, Kaufman SR, O L DeLancey J, Clemens JQ, Stoffel JT, et al. Understanding the dissemination of sacral neuromodulation. Surgical Innovation. 2013;20(6):625-30. DOI: https://doi.org/10.1177/1553350613485303