Neuromodulation in the Older Woman: An Advanced Treatment Option for Urgency Urinary Incontinence

Purpose of Review: Urgency urinary incontinence (UUI) disproportionately impacts older women, and treatment strategies should minimize known harms while optimizing benefits. In the present review, we seek to provide an overview of the recent literature as it relates to neuromodulation and the treatment of older women with UUI. We also highlight recent innovations to neuromodulation therapy which have the potential to significantly improve access to neuromodulation for older women, in addition to improvements in longevity and cost-effectiveness. Recent Findings: With respect to sacral neuromodulation (SNM) in older women, a randomized trial of women with non-neurogenic UUI found that older women undergoing SNM did not experience differential incontinence outcomes compared with younger women. In a separate retrospective cohort study, higher decade of age was found to be associated with lower odds of implantation and higher addition of therapies post-implantation. The development of a new MRI-compatible SNM lead has increased the number of eligible patients for SNM and the increased longevity of the new pulse generator will decrease the need for repeat surgery for generator replacements. With respect to posterior tibial nerve stimulation (PTNS), a significant barrier to access is currently the requirement for in-office visits for treatment. Newer implantable posterior tibial nerve electrodes have shown promising short-term efficacy and would provide a way for home-based remote PTNS obviating previous transportation-based barriers.

Duke Scholars

Author Cindy Louise Amundsen Obstetrics and Gynecology, Urogynecology