Neuromodulation for Overactive Bladder

Neuromodulation is an FDA-approved treatment modality for overactive bladder. The AUA/SUFU guidelines for management of overactive bladder include neuromodulation as a third-line therapy after failure of more conservative therapies, such as behavioral modifications and pharmacotherapy. In this review, a brief history of the technology required to develop the implantable neuroprosthesis is discussed. We examine relevant neuroanatomy and the most recent discoveries for the pathophysiology of overactive bladder, and our current best understanding of the mechanism of action of neuromodulation is considered. The three routes for neuromodulation, sacral, pudendal, and posterior tibial, are discussed individually, with outcomes, complication, and cost data reviewed for each modality. Finally, an update of future developments in neuromodulation is included. This review contains 8 highly rendered figures, 2 tables, and 71 references Key words: adverse event, implantable neurostimulators, neuromodulation, overactive, percutaneous tibial nerve stimulation, pudendal neuromodulation, sacral neuromodulation, spinal nerve roots, surgical intervention, urge urinary incontinence, urinary bladder