Alternative approaches to sacral nerve stimulation.

Bladder dysfunction is a very prevalent disorder and often refractory to behavioral and pharmacologic therapies. Sacral nerve stimulation is an approved method of managing urinary urgency, frequency, urge incontinence, and urinary retention. Alternative approaches to neuromodulation are being developed. The purpose of this paper is to describe emerging approaches to neuromodulation for voiding dysfunction. A current review of alternative methods of neuromodulation is discussed. This includes stimulation of the tibial nerve via a percutaneous approach, methods of stimulating the pudendal nerve to obtain afferent stimulation through sacral roots S2-S4, chemo-neuromodulation using botulinum toxin, and anogenital stimulation. These various methods are described and the current literature reviewed. Neuromodulation is an alternative to traditional management of voiding dysfunction. A benefit of neuromodulation is that it is minimally invasive and reversible. New sites of stimulation are being developed to add to our treatment options.