Neuromodulation
Neuromodulation procedures for OAB, urgency urinary incontinence, retention, and fecal incontinence now live on procedure-specific pages:
| Page | Use it for |
|---|---|
| Sacral Neuromodulation | Implanted S3 lead + pulse generator systems, test phase, programming, device revisions |
| Percutaneous Nerve Evaluation | Office-based temporary S3 test stimulation before permanent SNM implantation |
| Percutaneous Tibial Nerve Stimulation | PTNS, TTNS, implantable tibial nerve stimulation, office-maintenance counseling |
How to Use This Hub
Neuromodulation is a treatment family, not a single procedure. The shared idea is electrical modulation of bladder, bowel, pelvic-floor, and afferent sensory circuits, but the operations differ sharply in invasiveness, maintenance burden, reversibility, and patient selection.
| Clinical problem | Main neuromodulation option |
|---|---|
| Refractory urgency urinary incontinence / OAB | PTNS, SNM, or intradetrusor botulinum toxin depending patient preference and retention risk |
| Non-obstructive urinary retention | SNM after obstruction is excluded |
| Fecal incontinence | SNM is the stronger surgical neuromodulation option; PTNS evidence is mixed |
| Patient wants the least invasive option | PTNS / TTNS, accepting maintenance burden |
| Patient wants durable implanted therapy | SNM after a successful test phase |
Key Distinctions
- SNM targets the S3 sacral nerve root with an implanted lead and pulse generator. It requires a test phase, device programming, and long-term device surveillance.
- PNE is not definitive treatment. It is a temporary screening procedure used to decide whether permanent SNM implantation is justified.
- PTNS stimulates the posterior tibial nerve, usually in the office, and avoids an implanted sacral device but requires induction and maintenance sessions.
Practical Counseling
The most important preoperative question is whether the patient can live with the maintenance model. Some patients prefer monthly PTNS visits to an implant; others prefer implanted SNM to repeated office visits. A failed PTNS trial does not automatically mean SNM will fail, because the target and stimulation strategy differ.
For device hardware, see the neuromodulation-device pages under Tools / Biomaterials, including eCoin, Axonics, and Medtronic InterStim profiles.