Which patient factor is important when selecting SNM therapy?

• A. Age over 75 only.
• B. Presence of comorbid diabetes.
• C. Refractory lower urinary tract symptoms or fecal incontinence despite conservative therapy.
• D. History of pelvic radiation.

Answer: (C)

Choosing SNM therapy hinges on whether symptoms have persisted despite conservative treatment. This approach targets patients who have tried non-surgical measures—like pelvic floor therapy, bladder training, and medications—and still experience bothersome lower urinary tract symptoms or fecal incontinence. The standout factor is that symptoms are refractory to these less invasive options, meaning neuromodulation is being considered after less aggressive treatments have failed to provide adequate relief.

Age by itself, diabetes, or a history of pelvic radiation aren’t absolute deal-breakers and don’t define candidacy the way treatment history does. They may influence overall risk, comorbidity management, or device considerations, but the decisive criterion is persistent symptoms after conservative therapy, indicating a potential benefit from sacral nerve modulation. SNM works by modulating the nerves that control bladder and bowel function, and suitable candidates are typically those willing to proceed with implantation and follow-up after trying first-line therapies.