Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction

Temporary electrical stimulation using anal or vaginal electrodes and an ex ternal pulse generator has been a treatment modality for urinary urge incon tinence for nearly three decades. In 1981 Tanagho and Schmidt introduced ch ronic electrical stimulation of the sacral spinal nerves using a permanentl y implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refrac tory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacra l spinal nerve has been used for treatment of vesicourethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting sy mptomatic improvement by more than 50 % could be achieved in 13 of 18 patie nts with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %), Implants offer a sustained therapeutic effect to treatment responders, whic h is not achieved by temporary neuromodulation. Chronic neuromodulation sho uld be predominantly considered in patients with urinary retention. Further more in patients with motor urge incontinence, refusing temporary technique s or in those requiring too much effort to achieve a sustained clinical eff ect. Despite high initial costs chronic sacral neuromodulation is an econom ically reasonable treatment option in the long run, when comparing it to th e more invasive remaining therapeutic alternatives.