[Guidelines for the treatment of urinary incontinence in women with refractory idiopathic vesical hyperactivity using sacral neuromodulation]

Precise regulations should be respected when using neuromodulation of the sacral nerve roots in treating urinary incontinence in women with vesical hyperactivity. It is not recommended to perform a neuromodulation test of the sacral roots in management of urinary incontinence caused by vesical hyperactivity if rehabilitation or anticholinergic treatment has not been attempted, unless a contraindication prevents use of these treatments. The urologist implanting the device will have had specific training on the implantation material, the implantation technique, and parameterization. Assessment of the efficacy during the test period should be rigorous and based on use of voiding diaries, symptom questionnaires, as well as the patient's overall evaluation. Improvement greater than 50% and a counter test verifying the reappearance of symptoms after stimulation is interrupted are necessary to warrant implantation of a neuromodulator. Complete information should be given to patients before the test is performed. This will detail the test procedure, how to keep a voiding diary, the safety precautions, and the incidents that may occur.