ABSTRACT
Clinical manifestations of urinary voiding dysfunction include urge incontinence, urgency-
frequency, and urinary retention. Patients with nonobstructive urinary retention have few
treatment options except intermittent catheterization. The treatment of refractory detrusor
overactivity represents one of the most challenging problems in urology. Conservative treatment
rarely results in a durable cure of patients with urge incontinence and bladder overactivity.
Pharmacologic and behavioral techniques result in total cure in ,50% of patients (1). Once behavioral and pharmaceutical options have failed, these patients have been traditionally been
offered more invasive treatments such as bladder augmentation. While effective, this technique
is highly invasive and irreversible, and it carries significant complication rates. Other minimally
invasive surgical treatments for refractory detrusor overactivity, such as transvaginal detrusor
denervation, produce unreliable results. Detrusor myomectomy represents a potential treatment
option, but this technique has not been widely studied. Sacral neuromodulation offers an
alternative, reversible minimally invasive treatment for patients with urge incontinence, urinary
urgency-frequency syndrome, and nonobstructive, nonneurogenic urinary retention refractory to
conservative therapy.
