![]() The pudendal nerve receives information from Onuf’s nucleus in the S2–S4 level and innervates the skeletal muscle of the pelvic floor/external urethral sphincter. In the human, stimulation of the parasympathetic system through the pelvic nerves (S2–S4) leads to bladder emptying, and stimulation of the sympathetic system through the hypogastric nerves (T10–L2) leads to inhibition of bladder emptying. The delicate balance of stimulation and inhibitionĪ review of the neuroanatomy helps to explain the possible underlying mechanism of the workings of SNS. Therefore, considerable interest continues in the development of this method of therapy. ![]() This method of therapy has proven to be an alternative treatment for a difficult patient group-those in whom pharmacological and behavioral management have failed. In 1997, the sacral neuromodulation system, InterStim ( Medtronic Corp, Minneapolis, Minn), was FDA approved for treatment of urge incontinence, and, in 1999, for treatment of urinary frequency and urinary retention. SNS for lower urinary tract disorders has been under investigation in clinical trials since 1981 and in multicenter trials conducted during the late 1980s. Usually, the lead is implanted into the S3 sacral nerve root, and the impulse generator is placed in the upper buttock region. ![]() InterStim is an implantable system comprising a lead with 4 electrodes, an extension cable, and a programmable impulse generator. This article discusses several clinical trials that investigated its effectiveness, indications, and adverse events. The implantable InterStim device is FDA approved for the treatment of both storage and release disorders: SNS stimulates the sacral nerves to modulate the neural reflexes that influence the bladder sphincter and pelvic floor. The neuromodulation technique has been used for treatment of other disorders such as deep brain stimulation for Parkinson’s disease and vagal nerve stimulation for epilepsy. In the past, the options were limited to radical surgical procedures such as urinary diversion, augmentation cystoplasty, or cystectomy. Sacral neuromodulation stimulation (SNS) offers a less invasive alternative treatment for a difficult challenge: how to improve quality of life for patients with refractory lower urinary/pelvic floor disorders. It was unclear whether there was a significant placebo effect on fecal incontinence Pain, wound problems, or lead fracture led to surgical revision in 15.5% Quality of life scores improved significantly
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