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lüll Sacral Neuromodulation Feloney MP; Stauss K; Leslie SWStatPearls-/-ä 2024[Jan]; ä (ä): äSacral neuromodulation (SNM) is a safe, efficacious, and minimally invasive advanced therapy indicated to treat urinary incontinence, urinary retention, urgency, frequency, and fecal incontinence in the United States for patients refractory to behavioral and pharmacologic treatment. In Canada and Europe, it is also indicated for chronic constipation. Sacral neuromodulation therapy was developed in 1982 by Tanagho and Schmidt, gaining FDA approval in 1997. To date, there have been more than 300,000 patients treated with sacral neuromodulation implants worldwide. Reviews suggest that between 16% to 29% of the population, with a few estimating up to 75%, experience some level of overactive bladder, including symptoms of urinary incontinence, urgency, or frequency. Additionally, an estimated 25% to 40% of patients experiencing overactive bladder fail to achieve satisfactory results after first and second-line therapy (behavioral modifications and pharmacotherapy, respectively). These patients have a refractory overactive bladder and may be eligible for SNM therapy. SNM has been proven to produce good clinical results in otherwise intractable cases. One study conducted by Siegel et al. evaluated the therapeutic success rate in 340 patients using SNM at 36 months. The success rate for overactive bladder was 83% for patients who underwent SNM implantation (95% CI). Additionally, 80% of patients reported improvement in all urinary symptoms. The mechanism of action of sacral neuromodulation is not completely understood. However, the therapy seems to modulate spinal cord reflexes and brain involvement via afferent signaling rather than direct motor stimulation of the detrusor or urethral sphincter. The most widely accepted theory suggests that SNM blocks or otherwise interfere with the afferent input to the sacral spinal cord, inhibiting detrusor overactivity and resulting in clinical relief of urinary frequency and urgency.ä |