Sacral nerve stimulation for overactive bladder symptoms

This study investigated sacral neuromodulation (SNM) as a treatment option for overactive bladder symptoms. Researchers concluded that SNM is associated with significant and sustained improvements in overactive bladder symptoms.

Bladder muscle over-activity is a common cause of urinary urgency and incontinence. While behavioral and drug therapy are the most common treatments prescribed, sacral neuromodulation (SNM) has been under the focus of investigation as a possible alternative. SNM involves minimally invasive surgery in which an electrical stimulator is implanted under the skin, usually in the region around the lower back or buttocks. Mild electrical pulses are delivered to the regional nerve, which are believed to help control bladder reflexes. Further high-quality studies are needed to determine the safety and effectiveness SNM in treating overactive bladder symptoms.

272 patients with overactive bladder symptoms were included in this study. All patients received treatment with SNM. Treatment outcome was followed-up for one year.

One year after SNM implantation, 82% of patients reported an improvement in overactive bladder symptoms of more than 50%. For patients with urinary incontinence before treatment, an average reduction of 60% was noted in the number of incontinence episodes per day following treatment with SNM, with 36% of patients achieving complete continence. For patients with urinary urgency or frequency before treatment, 68% experienced at least half as many episodes of urgency per day, with 64% of patients achieving a normal urination pattern (from an average of 13 voids per day to less than 8 voids per day). The overall success rate of SNM treatment was estimated to be 85% for overactive bladder symptoms, 79% for urinary incontinence, and 70% for urinary urgency or frequency. After the first year of treatment, 80% of patients reported marked improvements in urinary symptoms affecting everyday life.

Side-effects associated with SNM were noted in 30% of patients after device implantation. The most commonly reported side-effects included unwanted changes in stimulation intensity (reported in 12% of patients), pain at the implantation site (reported in 7% of patients), and infection at the implantation site (reported in 3% of patients). Most side-effects occurred within 3 months of implantation, were quickly resolved and few were noted to be serious (less than 1.5%). 

The researchers concluded that sacral neuromodulation (SNM) is a safe and effective treatment option for overactive bladder symptoms.

Most patients included in this study were female (91%). Results of sacral neuromodulation were not compared to a control group or other standard treatment modalities in this study.