June 13, 2023
Sacral neuromodulation (SNM) is a well-established third line therapy for refractory overactive bladder with or without urge incontinence and nonobstructive urinary retention. Historically, this therapy has been used mainly in women with these conditions; however, it's been shown to have a significant role in treating male patients as well.
Meghan A. Cooper, D.O., a urology consultant at Mayo Clinic in Rochester, Minnesota, is working to increase the use of this therapy in male patients and provide this treatment as an additional option when behavioral and pharmacological interventions for these conditions have not been effective for male patients.
Overactive bladder is a common urologic condition affecting 10% to 16% of males. It is defined as a complex of symptoms with urinary urgency and frequency, with or without urge incontinence. Typically, it is treated with behavioral modifications, medications or both. However, refractory cases often go untreated in this population. SNM works by modifying the voiding reflex by stimulating the S3 afferent nerve. And SNM has an efficacy of 80% to 85% in women, with up to 50% of patients with incontinence becoming completely dry. Unfortunately, the efficacy in men is not well documented mainly due to underuse in this patient population.
The procedure, called a peripheral nerve evaluation (PNE), offers the patient a trial of the therapy for up to a week prior to any permanent implantation. This can take place in the clinic under local anesthesia or the operating room under sedation and only requires a small needle inserted into the sacral area with an externalized temporary lead. This affords the patient the ability to "test drive" the therapy with a minimally invasive procedure and very little risk.
If the procedure is successful — defined as greater than 50% improvement in symptoms — the temporary lead is removed in the clinic. Then the patient proceeds to the operating room for an outpatient procedure for placing the permanent lead and battery, which only requires a small incision in the upper buttock area. Trained staff and medical device representatives support the patient throughout the trial and after permanent implantation to aid in adjusting the stimulation as needed.
Dr. Cooper has already received an influx of referrals for male patients who thought there were no other options, and these patients were pleasantly surprised to learn they may be good candidates for this therapy. Many of the male patients who have success with SNM have already undergone bladder outlet procedures in the past for benign prostatic hypertrophy, but their urinary urgency and frequency persisted.
Additionally, patients with neurogenic bladders, such as those with Parkinson's or multiple sclerosis, or those who have had pelvic radiation also have benefitted from this therapy. Dr. Cooper looks forward to expanding the research landscape in this area by looking at the efficacy of SNM in men compared with women, as well as examining the voiding parameters that may predict success in male patients with overactive bladder or nonobstructive urinary retention.
For more information
Refer a patient to Mayo Clinic.