Abstract
Overactive bladder (OAB) affects millions of people worldwide yet first-line treatments are often poorly tolerated and compliance rates are low. Neuromodulation works via afferent nerve modulation and offers a minimally invasive and reversible alternative treatment option for patients with OAB who have failed first-line therapy. Neuromodulation has revolutionized the management of OAB and is now well established as a safe and effective treatment for those refractory to conservative treatments. Multiple neuroanatomical pathways have been described for sacral neuromodulation including the S3 nerve root, pudendal nerve and tibial nerve. The S3 nerve root is currently the main treatment target and has the most long-term data on safety and efficacy to support its use. However, studies on neuromodulation at the pudendal nerve or posterior tibial nerve have been positive and their role in treatment continues to evolve. Most urologists who are experienced in voiding dysfunction can become proficient in each technique. Patient selection, surgical techniques and postoperative management differ slightly between approaches and urologists should familiarize themselves with these differences. Treatment of OAB should progress from the least to most invasive modality, and neuromodulation provides an attractive option owing to its minimally invasive approach, tolerability, positive outcomes and reversibility.
Key Points
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Overactive bladder (OAB) is defined by the International Continence Society (ICS) as a syndrome characterized by urgency, with or without urgency incontinence, usually with frequency and nocturia
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Initial treatment options for OAB include behavioural modification, pharmacotherapy and physical therapy, either as monotherapies or in combination
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Neuromodulation is hypothesized to relieve OAB symptoms by modifying somatic afferent sensory processing in the sacral spinal cord
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Sacral, tibial or pudendal nerves can be targeted by neuromodulation with specific indications and techniques for each
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Treatment of OAB should progress from the least to most invasive modality, and neuromodulation provides an attractive option owing to its minimally invasive approach, tolerability, positive outcomes and reversibility
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J. Bartley researched data for the article. J. Bartley and J. Gilleran wrote the article. All authors contributed to the discussion of content and reviewed the manuscript before submission.
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K. Peters declares he has been a consultant for Medtronic and Uroplasty. J. Bartley declares she has been a speaker for Uroplasty. J. Gilleran declares no competing interests.
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Bartley, J., Gilleran, J. & Peters, K. Neuromodulation for overactive bladder. Nat Rev Urol 10, 513–521 (2013). https://doi.org/10.1038/nrurol.2013.143
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DOI: https://doi.org/10.1038/nrurol.2013.143
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