The role of neuromodulation in the management of urinary urge incontinence

Neuromodulation is increasingly becoming an important part of the treatment strategy for bladder dysfunction. In this issue a group of urologists have analysed outcome measures from all patients in pivotal clinical trials who have had this treatment, and have suggested that sacral nerve stimulation has an vital role in the management of refractory overactive bladder and retention problems. In a carefully performed study, authors from Mansoura and Scottsdale have evaluated high‐energy TUMT and found that although symptomatic improvement occurred in 82.5% of patients, and that the peak flow rate improved from a median of 9.2 to 15 mL/s, pressure‐flow improvement occurred in just 50% of the group. However, they found that younger patient age and higher grade of obstruction, are good predictors of urodynamic and symptomatic success respectively. In another study, Marshall's group from Adelaide emphasize the value of urodynamics and other factors in patients having TURP. The value of trans‐abdominal ultrasound is described by Foo and his colleagues from Singapore, who state that intravesical protrusion of the prostate is an important indicator of bladder outlet obstruction. OBJECTIVE To examine the benefit‐risk profile of neuromodulation in treating refractory urinary urge incontinence and other voiding disorders. PATIENTS AND METHODS The outcome measures from all patients in pivotal clinical trials who had undergone sacral nerve stimulation were analysed retrospectively. RESULTS Neuromodulation was effective in several clinical studies; the response is durable and the benefit‐risk profile good. CONCLUSION Sacral nerve stimulation is becoming the standard of care for refractory overactive bladder and retention problems. The potential benefit of neuromodulation should be included in female urology and gynaecology training programmes.