ABSTRACT
Female voiding dysfunctions such as those related to overactive bladder (OAB) syndrome and nonobstructive urinary retention often are refractory to conservative management including drug therapy, behavioral therapy, pelvic floor muscle exercises, biofeedback, noninvasive or minimally invasive neuromodulation, and intermittent selfcatheterization. Sacral nerve neuromodulation has proved to be valuable in these situations [1]. In 1997, the food and drug administration (FDA) approved sacral neuromodulation for treatment of refractory urge urinary incontinence in the united states. Subsequently, approval was also granted for the treatment of urgency–frequency syndrome and for nonobstructive urinary retention. The labeling was later changed to include "overactive bladder" as an appropriate diagnostic category [2]. In spite of the fact that its mechanism of action is far from understood [3–6], the list of urological applications now includes refractory urgency incontinence, the urgency– frequency syndrome, nonobstructive urinary retention, interstitial cystitis, and chronic pelvic pain/painful bladder syndrome. The latter two are not fda-approved indications, but the inclusion of interstitial cystitis is justified by the features of urinary frequency and urgency (with pelvic pain) [2]. The value of sacral neuromodulation (SNM) has now generally been recognized [7], and the therapy has been incorporated in guidelines and treatment algorithms such as those of the international consultation on incontinence [8].
