• Matthias Oelke, Mustapha Addali, and Christl Reisenauer.
• Department of Urology, Pediatric Urology and Urologic Oncology, St. Antonius Hospital, Möllenweg 22, 48599, Gronau, Germany. matthias.oelke@st-antonius-gronau.de.
• Arch. Gynecol. Obstet. 2019 May 1; 299 (5): 1243-1252.

PurposeTo inform uro-gynecologists about the current standards and latest developments of sacral neuromodulation (SNM) in women with overactive bladder (OAB).MethodsLiterature search in the PubMed database for articles published between 1988 and 2019 on SNM for OAB in women.ResultsIn total, 361 articles were identified and 51 articles retrieved for the review. SNM shows an objective success rate of 70-80%, OAB cure rate of 17-47% and a subjective satisfaction rate of 80-90%. These benefits have to be weighed against an adverse event rate of approx. 40%. SNM is significantly more successful than switching to another antimuscarinic after failed antimuscarinic drug therapy. Efficacy of SNM is slightly lower compared to bladder wall injections with 200 U botulinum toxin in the first months but efficacy of both treatments appears to be similar after 24 months. MRI examinations of patients with a sacral neurostimulator should only be performed after radiologist consultation. Sacral neurostimulators in patients with another pacemaker system should only be implanted after interdisciplinary consultation. The sacral neuromodulator should be turned off during pregnancy and delivery. SNM for OAB in patients with concomitant female sexual dysfunction or fecal incontinence seems to be beneficial.ConclusionsSNM is a successful and recommended second-line treatment of OAB. Sacral neurostimulators should preferably be implanted in SNM-centers because complications and the frequency of revisions are significantly reduced with increasing experience of the surgeon.

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