From the Guidelines
Sacral neuromodulation is a viable treatment option for urinary retention, fecal incontinence, and male anorgasmia, with success rates ranging from 60-80% for urinary and fecal issues, and promising results for anorgasmia. The procedure involves implanting a small device that sends mild electrical pulses to the sacral nerves, which control bladder, bowel, and sexual function. For urinary retention and fecal incontinence, sacral neuromodulation can improve muscle control and sensation, as seen in a study published in Clinical Gastroenterology and Hepatology 1, where 90% of 133 patients proceeded from temporary to permanent stimulation, and 36% reported complete continence after 5-year follow-up. For male anorgasmia, it may enhance sexual function by stimulating relevant nerve pathways, although results are less established, and treatment should be guided by the specific type of problem, as suggested by the NCCN Survivorship Panel 1. The treatment works by modulating nerve signals between the brain and pelvic organs, effectively "resetting" dysfunctional neural pathways, and can significantly improve quality of life for many patients. Some key points to consider include:
- The procedure typically involves a test phase with a temporary external device for 1-2 weeks to assess effectiveness.
- If successful, a permanent implant is surgically placed under the skin in the upper buttock area.
- The device is programmed externally and can be adjusted as needed.
- Patients should expect a period of adjustment and may need follow-up programming sessions.
- Sacral neuromodulation is particularly useful when conservative treatments have failed. It's also important to note that treatment of male sexual dysfunction, including anorgasmia, should include modification of risk factors, such as smoking cessation, weight loss, and increasing physical activity, as well as treatment of psychosocial problems, with referral to sex and couples therapy as appropriate 1.
From the Research
Sacral Neuromodulation for Urinary Retention, Fecal Incontinence, and Male Anorgasmia
- Sacral neuromodulation has been used as a safe and effective treatment option for patients with lower urinary tract dysfunction, including urinary retention 2, 3, 4, 5.
- The treatment has been shown to be effective in reducing symptoms of urinary retention, with a significant reduction in post-voiding residual volume and self-catheterization 2.
- Sacral neuromodulation has also been used to treat fecal incontinence, with studies showing significant improvements in symptoms 2, 3, 5.
- However, there is limited evidence on the use of sacral neuromodulation for male anorgasmia, and it is not a commonly reported indication for this treatment 2, 3, 4, 5, 6.
- The exact mechanism of action of sacral neuromodulation is not fully understood, but it is thought to modulate neural circuits in both central and peripheral pathways, having an impact on the brain and bladder-targeting neuronal activity 3, 6.
Efficacy and Safety of Sacral Neuromodulation
- Studies have reported high cure rates and low complication rates for sacral neuromodulation in the treatment of refractory overactive bladder syndrome and urinary retention 2, 6.
- The treatment has been shown to be effective in reducing symptoms of fecal incontinence, with significant improvements in incontinent episodes per week 5.
- Common adverse effects of sacral neuromodulation include pain at the implant site, lead migration, and technical failure, but there have been no reports of permanent injury or death 5, 6.
- Patients who undergo sacral neuromodulation have reported significant improvements in quality of life, with many recommending the procedure to others 5.