What uro-gynecologists should know about sacral neuromodulation (SNM) for the treatment of refractory overactive bladder
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To inform uro-gynecologists about the current standards and latest developments of sacral neuromodulation (SNM) in women with overactive bladder (OAB).
Literature search in the PubMed database for articles published between 1988 and 2019 on SNM for OAB in women.
In total, 361 articles were identified and 51 articles retrieved for the review. SNM shows an objective success rate of 70–80%, OAB cure rate of 17–47% and a subjective satisfaction rate of 80–90%. These benefits have to be weighed against an adverse event rate of approx. 40%. SNM is significantly more successful than switching to another antimuscarinic after failed antimuscarinic drug therapy. Efficacy of SNM is slightly lower compared to bladder wall injections with 200 U botulinum toxin in the first months but efficacy of both treatments appears to be similar after 24 months. MRI examinations of patients with a sacral neurostimulator should only be performed after radiologist consultation. Sacral neurostimulators in patients with another pacemaker system should only be implanted after interdisciplinary consultation. The sacral neuromodulator should be turned off during pregnancy and delivery. SNM for OAB in patients with concomitant female sexual dysfunction or fecal incontinence seems to be beneficial.
SNM is a successful and recommended second-line treatment of OAB. Sacral neurostimulators should preferably be implanted in SNM-centers because complications and the frequency of revisions are significantly reduced with increasing experience of the surgeon.
KeywordsOveractive bladder Urge incontinence Implantable neurostimulators Treatment efficacy Postoperative complications
MO: Protocol and project development; data collection and management; data analysis; manuscript writing and editing. MA: Data analysis; manuscript writing and editing. CR: Data collection and management; data analysis; manuscript writing and editing.
Compliance with ethical standards
Conflict of interest
M Oelke has received for OAB a speaker honorarium from Astellas, Duchesnay, Pierre Fabre and Pfizer, is advisory board member of Astellas and Pfizer, received research grants from Astellas and Pfizer, and participated in clinical trials from Apogepha, Astellas and Pfizer. M Addali has no conflict of interest. C Reisenauer has received a speaker honorarium from Astellas, Boston Scientific, Coloplast and Medtronic.
This article does not contain any studies with human participants or animals performed by any of the authors.
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