We present a feasibility study concerning the choice of establishing a dedicated Sacral Neuromodulation (SNM) Unit within a Neurorehabilitation Department.

As advancements in both neuro-urology and neurorehabilitation techniques continue to evolve, the integration of specialized treatment modalities such as SNM has become increasingly essential for optimizing patient outcomes. SNM is worldwide recognized as an effective functional therapy to restore compromised lower urinary tract (LUT) and bowel dysfunction. LUT and bowel dysfunctions are eligible for SNM if refractory to conventional therapies. Neurorehabilitation is a specialized medical process designed to aid recovery and improve functional abilities of patients who have experienced neurological conditions. The approach is multidisciplinary and involves a team of healthcare professionals who work together to restore, compensate for or adapt to lost or impaired neurological function. The ultimate goal of neurorehabilitation is to help patients regain independence, enhance their Quality of Life (QOL) and reintegrate into their communities as fully as possible. 
Aim of our feasibility study was to demonstrate that incorporating an SNM unit in a Neurorehabilitation setting would provide a critical intersection between neurology, neuro-urology and rehabilitation, giving the patients a comprehensive care that addresses both their neurological and neuro-urological and bowel needs. 
Following 29 years of SNM activity in a Surgical Department, from August 2024 to the beginning of March 2026 every week we recovered 4 urological and coloproctological patients selected for SNM procedures in the Neurorehabilitation Department of our Spinal Unit (total of 196 patients). We followed patients for satisfaction  interviews, frequence of surgical infections of first stage procedures, percentage of positive outcomes of first stage procedures.

No modification in frequence of surgical infections were detected, if compared with previous data about first stage infections (2.4 vs 2.6%) [1]. Percentage of positive outcome of SNM tests was aligned with data in the literature [2]. Satisfaction interviews highlighted a high satisfaction rate referred to overall satisfaction and the quality of care process. The improvement of patients’ overall satisfaction was reported either in positive results of SNM tests or in negative ones.

Positive reports in satisfaction interview in spite of clinical results of SNM tests could correlate with the effect of comprehensive care in optimizing patients outcomes. The unchanged frequence of post-operative infections even in a rehabilitation ward might sustain that surgical ward admission may not be required.

The presence of a specialized SNM Unit within a Neurorehabilitation setting improved patient adherence to the functional treatment, independently from the result test. An adequate setting may potentially reduce the long-term burden of chronic functional urological conditions.

Agnello M, Brugnano S, Vottero M, Bertapelle P. Infection Rate of a Prolonged Sacral Neuromodulation Test: A Large Retrospective Study. Neuromodulation. 2023 Dec;26(8):1845-1850. doi: 10.1016/j.neurom.2022.08.453. Epub 2022 Oct 4. PMID: 36202715.
Chartier-Kastler E et al. Sacral Neuromodulation with the InterStim™ System for Intractable Lower Urinary Tract Dysfunctions (SOUNDS): Results of Clinical Effectiveness, Quality of Life, Patient-Reported Outcomes and Safety in a French Multicenter Observational Study. Eur Urol Focus. 2021 Nov;7(6):1430-1437. doi: 10.1016/j.euf.2020.06.026. Epub 2020 Sep 7. PMID: 32907782.