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Treatment using sacral nerve neuromodulation (SNM), also known as indirect sacral nerve stimulation, is one of several alternative modalities for patients with fecal or urinary incontinence (urge incontinence, significant symptoms of urgency-frequency, nonobstructive urinary retention) who have failed behavioral (e.g., prompted voiding) and/or pharmacologic therapies. Urge incontinence is defined as leakage of urine when there is a strong urge to void. Urgency-frequency is an uncontrollable urge to urinate, resulting in very frequent, small volumes and is a prominent symptom of interstitial cystitis. Urinary retention is the inability to completely empty the bladder of urine. Fecal incontinence can arise from a variety of mechanisms, including rectal wall compliance, efferent and afferent neural pathways, central and peripheral nervous systems, and voluntary and involuntary muscles. Fecal incontinence is more common in women, due mainly to muscular and neural damage that may occur during vaginal delivery.
The SNM device consists of an implantable pulse generator that delivers controlled electrical impulses. This pulse generator is attached to wire leads that connect to the sacral nerves, most commonly the S3 nerve root. Two external components of the system help control the electrical stimulation. A control magnet, kept by the patient, is used to turn the device on or off. A console programmer is kept by the physician and used to adjust the settings of the pulse generator.
Several sacral nerve neuromodulation devices have been approved by the U.S. Food and Drug Administration (FDA) through the premarket approval process. The InterStim™ and InterStim II® System have been approved for the treatment of urinary retention and symptoms of overactive bladder in patients who have failed or could not tolerate more conservative treatments. These products have also been approved for the treatment of chronic fecal incontinence in patients who have failed or are not candidates for more conservative treatments. The Axonics SNM System® has received FDA approval for the treatment of urinary retention and the symptoms of overactive bladder, including urinary urge incontinence and significant symptoms of urgency-frequency in patients who have failed or could not tolerate more conservative treatments.
I. Urinary Incontinence and Nonobstructive Retention
II. Fecal Incontinence
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