Optimizing Lead Placement in Sacral Neuromodulation

Purpose of review Sacral neuromodulation remains an effective therapy for multiple conditions and both the technology and implant techniques have evolved over more than two decades. Understanding of the ideal conditions for testing and administration of the therapy continue to progress as well, though considerable controversy still exists. This review seeks to clarify the current knowledge and opinion surrounding types of neuromodulation testing, what constitutes an optimized lead and best practices for maximizing therapeutic success. Recent findings There are distinct advantages and disadvantages to each method of sacral neuromodulation testing that should be individualized to each patient. While motor response during lead implantation may be more reliable and even necessary, an approach which balances both motor and sensory data may be advantageous. Optimized lead placement, though not conclusively proven to offer definite advantages, remains a laudable goal for most implantations. Sacral neuromodulation remains an important therapy for patients with pelvic voiding and elimination dysfunction. Important considerations including office-based or staged testing, motor or sensory prioritization, and the importance of lead optimization remain debatable. However, there remain important lessons that can influence the likelihood of successful therapy. Although there is still work to be done, we are continuing to strive for improvement in patient outcomes as a result of optimized lead placement in sacral neuromodulation.