Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects.

Sacral Neuromodulation (SNM) is a minimally invasive, guideline-recommended treatment for OAB patients following failure of conventional interventions. Patient selection, lead placement and testing technique are important pillars in optimizing the success of this therapy.

A comprehensive literature search was conducted on 'sacral neuromodulation' and 'overactive bladder'. There was no date restriction on the searched articles with the last search dated 31 May 2021. Patient selection, lead placement, different test phases, safety and efficacy, and a market overview of available devices are thoroughly discussed with the ultimate goal to maximize the likelihood of successful SNM therapy. Differences between the rechargeable and non-rechargeable devices will be highlighted. Lastly, future perspectives will be presented with the anticipated trajectory of sacral neuromodulation over the next five years.

SNM has proved to be a safe and effective therapy on the short-, medium- and long-term without precluding any other treatment options. In all studies reviewed, no life threatening or major irreversible complications were presented. However, surgical re-intervention rates were high with a median of 33.2% (range: 8-34%) in studies with at least 24 months follow-up. Unfortunately, no true consensus could be made regarding prognostic factors. However, optimized lead placement, consequent ideal motor thresholds and the use of a curved stylet theoretically facilitates reaching maximal success with SNM. Test phase success rates increased to such a level that from a cost-effective point of view, single stage implants could be considered.

Expert review of medical devices. 2022 Jan 21 [Epub ahead of print]

Sam Tilborghs, Stefan De Wachter

Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium.