Update on neuromodulation for frequency, urgency, retention, and neurogenic voiding dysfunction

Neuromodulation offers a reversible and minimally invasive treatment for patients with urge incontinence, urinary urgency-frequency syndrome, and nonobstructive urinary retention that is refractory to conservative therapy. Despite many advances in the techniques of neuromodulation, the mechanism of neuromodulation of bladder function remains undefined. It seems to involve activation of peripheral afferent nerves and may influence bladder function in part through a supraspinal mechanism. Neuromodulation of bladder function is clinically available via US Food and Drug Administration-approved techniques of sacral nerve root stimulation and posterior tibial nerve stimulation. Sacral neuromodulation has emerged as the preferred treatment for symptoms that are refractory to conservative management. Few predictors of response to sacral neuromodulation have been identified. Alternative, more peripheral forms of neuromodulation for bladder dysfunction such as pudendal and dorsal genital nerve stimulation are being studied. © 2009 Current Medicine Group, LLC.