A Prospective Preliminary Study of Sacral Neuromodulation for Female Pelvic Floor Dysfunction

It is well established that lower urinary tract symptoms (LUTS) in women (particularly urinary urgency and incontinence and fecal incontinence) are associated with considerable emotional distress, interference with daily activities, feelings of social isolation, and decreased work productivity. Many of these women also suffer from pelvic pain as part of this global pelvic floor dysfunction. It is well known that pregnancy and childbirth are associated with pelvic floor dysfunction and urinary incontinence which may not manifest for years or decades following the inciting event of childbirth. Many women have urinary, bowel, and pain symptoms that are inadequately treated by non-surgical means. Implantable stimulators that provide continuous electrical stimulation to the nerves supplying the bladder and pelvis have been associated with overall benefits in patients with pelvic floor dysfunction in some studies. This unique treatment allows for a “test” phase in which an electrical lead is placed externally (without stimulation) prior to a second phase where implantation of the permanent stimulator device occurs. There is, however, a lack of understanding of the relative impact of sacral neuromodulation (SNS) on urinary symptoms, bowel and pain symptoms when compared with individuals who are refractory to medical therapies but do not undergo surgical intervention. Understanding which women may benefit most from SNS in any or all domains (urinary, bowel, and pain) will lead to better patient selection and allow the treating physicians from all disciplines to better counsel patients regarding patient outcomes and expectations.