Past, Present, and Future Implantable Neuromodulation Treatments for Management of Urinary Urge Incontinence (UUI): Implications for Clinical Effectiveness and Safety

PURPOSE OF THE REVIEW: This review examines the progress made in neuromodulation therapies for UUI since the original introduction of SNM devices until now. There are multiple current commercial neuromodulation therapies from which to choose, including those with sacral or tibial nerve targets. The intent is to provide critical evidence to help clinicians decide which device to offer their patients. RECENT FINDINGS: Modern SNM systems consistently outperform both previous-generation SNM and contemporary iTNM. Modern SNM demonstrates substantially higher effectiveness than pooled averages including early device studies with outdated study designs, tools and implant techniques. Current iTNM outcomes are comparable to legacy SNM yet remain markedly lower than modern SNM. Contemporary data supports a clear hierarchy-modern SNM offers the highest effectiveness and the most favorable safety profile. We believe that our field is moving toward minimally invasive, highly targeted, patient-directed SNM systems-an evolution that aligns with both clinical outcomes and patient preferences.