Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Neuromodulation versus neurotoxin for the treatment of refractory detrusor overactivity: for neuromodulation

Nature Clinical Practice Urology volume 5, pages 118–119 (2008)Cite this article

Sacral nerve modulation (SNM) has emerged as a new standard of care for the treatment of refractory overactive bladder/detrusor overactivity (DO) and idiopathic nonobstructive urinary retention (NOUR). SNM is also used for the treatment of gastrointestinal dysfunctions, including fecal incontinence, fecal urgency and frequency, and chronic constipation, which are among the main indications for SNM in Europe.1 To date, over 40,000 implants have been performed worldwide.2

The clinical outcomes of patients with DO or NOUR treated with SNM are very promising. A number of randomized controlled studies have shown that 80% of patients with refractory DO who undergo this therapy experience a >50% reduction in their urge urinary incontinence (UUI).3 Two-thirds of patients with refractory DO have improvements in their frequency and urgency,4 and 61% of patients with NOUR are able to eliminate the use of catheters.5 Long-term efficacy data are also excellent, with 5-year post-implant success rates of 68% for UUI, 56% for urgency and frequency, and 71% for retention. In fact, control of symptoms at 1 year is predictive of a 70–90% success rate at 5 years.6 Outcomes depend somewhat on patient selection: factors that predict the highest success rate with SNM for UUI are age <55 years, a non-neurogenic etiology of symptoms and minimal comorbidities.7 A carefully selected candidate for SNM will have a 60–70% chance of obtaining substantial benefit from this therapy, with great potential for long-term improvement. While previous series have reported reoperation rates as high as 33%,3 contemporary series have demonstrated a significant reduction in this figure to <20%.8 Pain at the implantable pulse generator (IPG) site or lead site used to be the main reasons for reoperation; currently, however, the main reasons are loss of efficacy of the IPG or infection. These changes reflect a number of improvements in the therapy, including the standard use of fluoroscopy and the staged technique with lead placement under local anesthetic or sedation. An extended trial period before IPG placement has also served to decrease the likelihood of new pain. Improved flexibility in patient programmability, buttocks placement and miniaturization of the IPG are also responsible for a reduced reoperation rate owing to IPG and lead pain. This procedure is safe, with a low rate of associated morbidity, is reversible, will not cause urinary retention, and has an >80% likelihood of long-term patient satisfaction.9 In addition, gastrointestinal symptoms might be improved if the patient has gastrointestinal dysfunction.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Bernstein AJ and Peters KM (2005) Expanding indications for neuromodulation. Urol Clin North Am 32: 59–63

    Article  Google Scholar 

  2. Medtronic Inc. website [http://www.p.medtronic.com/Newsroom/NewsReleaseDetails.do?itemId= 1193922073226&lang=en_US] (accessed 17 December 2007)

  3. Brazzelli M et al. (2006) Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. J Urol 175: 835–841

    Article  Google Scholar 

  4. Hassouna MM et al. (2000) Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. J Urol 163: 1849–1854

    Article  CAS  Google Scholar 

  5. Jonas U et al. (2001) Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol 165: 15–19

    Article  CAS  Google Scholar 

  6. van Kerrebroeck PE et al. (2007) Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol 178: 2029–2034

    Article  Google Scholar 

  7. Lemack GE et al. (2007) Highlights from the combined Society of Urodynamics and Female Urology, and International Society of Pelvic Neuromodulation annual meeting. J Urol 177: 691–695

    Article  Google Scholar 

  8. Van Voskuilen AC et al. (2007) Medium-term experience of sacral neuromodulation by tined lead implantation. BJU Int 99: 107–110

    Article  Google Scholar 

  9. Borawski KM et al. (2007) Predicting implantation with a neuromodulator using two different test stimulation techniques: A prospective randomized study in urge incontinent women. Neurourol Urodyn 26: 14–18

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. N Nakib is a Female Urology Fellow at and S Siegel is the Director of the Twin Cities Continence Care Center of Metropolitan Urologic Specialists, St. Paul, MN, USA.,

    Nissrine Nakib & Steven Siegel

Authors
  1. Nissrine Nakib
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven Siegel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven Siegel.

Ethics declarations

Competing interests

N Nakib has declared that she is a consultant for American Medical Systems and Coloplast.

S Siegel has declared that he is a consultant for, and has received a grant or research support from, American Medical Systems, Advanced Bionics and Medtronic. He is also a patent holder/applicant for American Medical Systems and Medtronic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nakib, N., Siegel, S. Neuromodulation versus neurotoxin for the treatment of refractory detrusor overactivity: for neuromodulation. Nat Rev Urol 5, 118–119 (2008). https://doi.org/10.1038/ncpuro1033

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro1033

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing