The future of neuromodulation for functional pelvic problems

Abstract

Neuromodulation is for over 30 years an effective and up-to-date technique in the treatment of patients with functional medical problems such as overactive bladder, non-obstructive urinary retention, and faecal incontinence. In clinical urological, uro-gynaecological and coloproctological practice, only the sacral and the tibial nerves have been used for neuromodulation for the time being, and the most commonly applied techniques are permanent sacral nerve stimulation with an implanted electrode and percutaneous tibial nerve stimulation. For the time being, neuromodulation is recommended only for patients who do not respond to standard treatments and before more invasive surgery. Minor and reversible complications can be seen after neuromodulation techniques, but can be resolved in most patients. Recent developments include better lead placement techniques, developments in programming, rechargeable and MRI-compliant batteries. These novelties reduced morbidity and have made neuromodulation more cost-effective. During the last 5 years, numerous innovative devices have been designed and investigated to address the limitations of currently available hardware and other nerve targets have been explored. In the future the emergence of alternative stimulation sites and programmes as well as further technical and technological developments, may expand the clinical application of neuromodulation in patients with functional pelvic problems, increase the success rate and reduce the complication rate.

Keywords

• Neuromodulation
• Lower urinary tract dysfunction
• Faecal incontinence
• Implantable neurostimulator
• Sacral nerve
• Tibial nerve