Sacral neuromodulation (SNM) is an effective treatment of refractory voiding dysfunction; however, the mechanism of action is only partially understood. Evidence has shown that SNM acts by way of the afferent pathway at the cortical level. The modification of somatosensory-evoked potentials induced by SNM seems to be prognostic of the clinical outcomes. Moreover, evidence has demonstrated that positive quadripolar test stimulation with InterStim SNM is more likely when intraoperative lead placement results in a positive motor response vs a sensory response only. The possibility of factors predictive of the clinical outcome is important, because SNM is associated with a significant cost. Furthermore, despite the use of a new percutaneous approach, a minimally invasive operation, the complication and revision rates associated with this technique are rather significant. More studies evaluating the long-term efficacy of SNM are needed, because this technique is increasingly being used.
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