How sacral nerve stimulation neuromodulation works.

The authors believe that the principles underlying the multiple possible SNS mechanisms of action can be summarized as somatic afferent inhibition of sensory processing in the spinal cord. Regardless of whether the lower urinary tract dysfunction involves storage versus emptying abnormalities, the pudendal afferent signaling serves as a common crossroads in the neurologic wiring of the system. Not only can pudendal afferent input turn on voiding reflexes by sup-pressing the guarding reflex pathways, pudendal afferent input to the sacral spinal cord also can turn off supraspinally mediated hyperactive voiding by blocking ascending sensory pathway inputs. For these reasons, SNS can take advantage of the complex neurologic pathways described and offer successful treatment for a seemingly disparate group of lower urinary tract pathologies. SNS is a urologic technique that has proved safe and minimally invasive, and it holds great promise for many patients who have lower urinary tract dysfunction.