Neuromodulation in urology, state of the art. Issue 4 (November 2019)

• Record Type: Journal Article
• Authors: Ammirati, Enrico; Giammò, Alessandro; Manassero, Alberto; Carone, Roberto
• Is Part Of: Urologia journal. Volume 86:Issue 4(2019)
• Page Start: 177
• Page End: 182
• Publication Date: 2019-11
• Subjects: Sacral neuromodulation -- percutanous tibial nerve stimulation -- overactive bladder -- non-obstructive urinary retention -- interstitial cystitis -- bladder pain syndrome; Urology -- Periodicals; 616.6005
• DOI: 10.1177/0391560319866075
• Languages: English
• ISSNs: 0391-5603

Abstract

Sacral neuromodulation is an approved and validated treatment for overactive bladder syndrome, chronic non-obstructive retention, and chronic pelvic pain. Percutaneous tibial nerve stimulation is a less invasive approach of neuromodulation. We performed a literature research to assess the current evidence available about neuromodulation. Both techniques appear to be effective and safe third-line treatments. The overall success rate ranges from 43% to 85% for sacral neuromodulation and from 40% to 79.5% for percutaneous tibial nerve stimulation. Sacral neuromodulation has a higher incidence of complications in comparison to percutaneous tibial nerve stimulation, due to the more invasive surgical technique and the presence of a permanent implant. The incidence of surgical revision ranges between 9% and 33%. The most frequent complication with sacral neuromodulation is pain at implant site (15%–42%), followed by lead migration (4%–21%), pain at lead site (5.4%–19.1%), leg pain (18%), and infection (5.7%–6.1%). The quality of the studies on sacral neuromodulation and percutaneous tibial nerve stimulation in literature is quite modest, because of the shortage of good randomized clinical trial; most of the studies are prospective observational studies with mid-term follow-up.