Expanding indications for neuromodulation.

Neuromodulation in one form or another has been studied for decades for various disease states. Although its mechanism of action remains un-explained, numerous clinical success stories suggest it is a therapy with efficacy and durability. Controlled studies have led to the approval of sacral neuromodulation for urinary urgency and frequency, urinary retention, and urinary urge incontinence. The future holds hopeful possibilities for the application of neuromodulation, namely in the areas of interstitial cystitis, in-tractable pain syndromes, fecal incontinence and constipation, spinal cord injury, and erectile dysfunction. Neuromodulators have also been used in nonurologic conditions, including chronic headaches and intractable chest pain. In adults and children, in the neurologically intact and neurologically impaired, neuromodulation has been shown to improve the quality of life of those suffering chronic disease states. Neuromodulation is changing the future of urology. Treatment of voiding dysfunction and likely other disorders, such as pelvic pain, sexual dysfunction, and bowel disorders, will no longer rely only on medications that are "OK" or destructive-reconstructive procedures that suffer from significant complications. Rather, by modulating the nerves, the urologists will treat these disorders in a minimally invasive fashion and neuromodulation will become the first-line therapy before any major surgery is undertaken.