Conclusion

The technique of sacral neuromodulation is available in neuro-urologic situations in which there is an imbalance between the neurological systems which regulate retention and micturition. It is generally used to treat vesical overactivity with pollakiuria, which disturbs patients' quality of life. The need to urinate can even trigger urinary or fecal leakage. When the pharmacological arsenal has been tried to no avail, sacral neuromodulation remains an alternative to urologic interventions of the bladder. Neu-rogenic and idiopathic overactive bladder must be differentiated, and it is essential to considerer psychological factors affecting the patient. Urologic etiologies are a contra-indication for sacral neuromodulation. The major indication is bladder overactivity, followed by idiopathic chronic retention and chronic pelvic pains. Sacral neuromodulation is a mini-invasive technique but requires methodological rigor and a preliminary percutaneous test. When selection is performed, more than three-quarters of the patients showed a clinically significant response, but the results vary according to the author's mode of evaluation. From the economic point of view, the initial investment in the device is amortized in the mid-term by savings related to lower urinary tract dysfunction. Finally, this technique requires an attentive follow-up and adjustments to the electric parameters so as to optimize the equilibrium between the neurological systems.

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