What is sacral neuromodulation, and in which patient population is it typically considered?

• A. A neuromodulation therapy that modulates sacral nerve activity to improve bladder function; for refractory urge, urge-predominant incontinence, or nonresponsive cases.
• B. A nerve-cutting procedure for stress incontinence.
• C. A physical therapy technique for pelvic floor strengthening.
• D. A pharmacologic agent used for mixed incontinence.

Answer: (A)

Sacral neuromodulation is a therapy that uses electrical stimulation of the sacral nerves to regulate bladder function. It typically involves an implanted device that delivers pulses to the sacral nerve roots (often targeting S3), which modulates the neural circuits controlling bladder storage and emptying. This approach is especially considered for patients with symptoms of urge incontinence or urgency-predominant incontinence who have not responded to conservative measures and pharmacologic treatment—so-called refractory or nonresponsive cases. It can also be used for nonobstructive urinary retention when other therapies have failed. It is not a nerve-cutting procedure, nor a physical therapy technique, nor a drug. A common pathway involves a trial stimulation to test responsiveness before a permanent implant is placed.