Off-Label but On-Target: Sacral Neuromodulation for Neurogenic Bladder Dysfunction.

Purpose of review: Neurogenic bladder dysfunction (NBD) is a frequent complication of neurological diseases including Parkinson's disease, multiple sclerosis, spinal cord injury, and spina bifida. Managing NBD remains challenging, especially for patients who fail to respond to standard therapies. Sacral neuromodulation (SNM), though FDA-approved for non-neurogenic conditions, is increasingly explored off-label in neurogenic populations.

Recent findings: Recent studies demonstrate that SNM can improve lower urinary tract symptoms, bladder storage, and emptying in select NBD patients. Small case series and retrospective reviews suggest reduced catheterization and medication use. Technological advances, such as closed-loop systems and MRI-compatible devices, are broadening SNM's clinical potential. SNM is emerging as a valuable, minimally invasive treatment for neurogenic bladder dysfunction. Careful patient selection and understanding of underlying pathophysiology are essential for success. As evidence grows and device innovations continue, SNM could reshape management strategies for patients with neurogenic bladder.