Sacral nerve stimulation: is intermittent stimulation just as effective?

This study examined a new variation of sacral nerve stimulation used to treat persistent urge urinary incontinence.

Researchers concluded that intermittent sacral nerve stimulation was as effective as continuous stimulation in treating urge urinary incontinence. 

Sacral nerve stimulation (SNM) is a type of treatment for patients with persistent urge urinary incontinence. It involves a 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. Previous studies have found SNM to be effective for some patients with persistent urge urinary incontinence. However, SNM requires frequent maintenance (such as battery changes) and often interferes with daily activities.

Intermittent SNM (in which the stimulator works for 8 hours, and is switched off for 16 hours of the day) may provide the same effective treatment, but also save battery life, reduce the likelihood of nerve damage, and improve user quality of life.

In this study, 19 women with persistent urge urinary incontinence received treatment with SNM over the course of 6 months. Data on urinary function were collected before the surgery, during conventional (continuous) SNM (stimulator is ‘on’ 24h/day), and during 12 weeks of intermittent SNM (simulator is ‘on’ 8h/day).

When compared to before the surgery, 12 patients (63% of patients) reported an improvement of at least 50% in incontinence episodes during intermittent SNM. Seven of these patients (37%) showed an improvement of at least 90%. The reported improvements included both reduced frequency and severity of incontinence.

There was no difference seen between intermittent SNM and conventional (continues) SNM. Both were found to be equally effective. This suggests that intermittent SNM could be an acceptable alternative to conventional SNM.

At the end of the study, 11 patients (58%) wished to continue treatment with intermittent SNM. Of these, eight requested to extend the ‘on’ period to 12 hours per day for an added sense of security. The other eight patients (42%) changed back to conventional SNM.

Researchers concluded that intermittent sacral nerve stimulation can be a simple, safe and efficient treatment for urge urinary incontinence. 

Larger clinical trials with longer follow-up are needed to confirm the results of this exploratory study.