Sacral Neuromodulation

Sacral Neuromodulation (SNM)

Sacral Neuromodulation (SNM) is a minimally invasive and reversible treatment for persistent pelvic floor disorders, including overactive bladder, non-obstructive urinary retention, and fecal incontinence. The treatment is based on electrical stimulation of the sacral nerve roots (usually S3) using an implanted device, with the aim of modulating the innervation pathways and restoring bladder and bowel function. SNM is recommended as a second-line treatment after failure of conservative and pharmacological treatments.
The treatment is particularly relevant in gynecology and urogynecology for women with persistent “overactive” bladder, idiopathic urinary retention, and dual incontinence (urine and fecal). Objective success rates are approximately 70–80%, with high satisfaction, although the rate of side effects is significant and includes infection, electrode migration, and device malfunction. The treatment is carried out in two phases: an experimental phase with a temporary electrode, and after demonstration of improvement in symptoms, permanent implantation is performed.
New studies also indicate possible efficacy in chronic pelvic pain, sexual dysfunction, and neurogenic bladder, although these are not yet FDA-approved conditions. Long-term follow-up is required due to the device's complications and the frequent need for reprogramming or replacement.
In conclusion, SNM is an established and effective treatment for resistant pelvic floor disorders in women, with expanding indications and ongoing research regarding its safety and efficacy in special populations such as pregnant women.