**5.3 Neuromodulation**

Neuromodulation can be utilized to increase pelvic muscle contraction and decrease detrusor contractions. The use of neuromodulation is assumes that OAB results from an imbalance of inhibitory and excitatory control systems of the detrusor that leads to the symptoms of OAB during the filling phase. (Fall and Lindstrom ,1991) Neuromodulation is gaining popularity because it bridges the gap between conservative treatments and highly invasive options. Currently, the methods used include sacral nerve modulation (SNM) via surgically implanted electrodes and other newer methods that deliver percutaneous stimulation of the peripheral tibial nerve.

The exact mechanism of action for neuromodulation is not well understood. However, many theories have been proposed as follows. (Al-Shaiji et al, 2011)

