In selecting patients for SNM therapy, which scenario would be a primary consideration?

• A. Urinary tract infection
• B. Mild nocturia responsive to lifestyle changes
• C. Refractory lower urinary tract symptoms or fecal incontinence despite conservative therapy
• D. Acute urinary retention easily resolved with meds

Answer: (C)

Sacral neuromodulation is considered when pelvic floor dysfunction persists despite noninvasive management. The key idea is that the patient has lower urinary tract symptoms or fecal incontinence that remain uncontrolled after trying lifestyle changes, medications, and other conservative therapies. An active urinary tract infection would prevent proceeding with an implant until it’s treated, since infection raises risk of complications. If nocturia is mild and already improves with lifestyle adjustments, SNM isn’t needed. Acute urinary retention that can be resolved with medications is a temporary problem, not a chronic, refractory condition that SNM targets. So the primary consideration is persistent symptoms despite conservative therapy.