Stimulation of the dorsal sacral nerve root using a permanent implantable device in the S3 sacral foramen has been developed for use in patients with both idiopathic and neurogenic detrusor overactivity. The sacral nerves contain nerve fibres of the parasympathetic and sympathetic systems providing innervation to the bladder as well as somatic fibres providing innervation to the muscles of the pelvic floor. The latter are larger in diameter and hence have a lower threshold of activation meaning that the pelvic floor may be stimulated selectively without causing bladder activity. Prior to implantation, temporary cutaneous sacral nerve stimulation is performed to check for a response, and if successful, a permanent implant is inserted under general anaesthesia. Initial studies in patients with detrusor overactivity refractory to medical and behavioural therapy have demonstrated that after 3 years, 59% of 41 urinary urge incontinent patients showed greater than 50% reduction in incontinence episodes with 46% of patients being completely dry . Whilst neuromodulation remains an invasive and expensive procedure in the future, it offers a useful alternative to medical and surgical therapies in patients with severe, intractable detrusor overactivity.
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