Neuromodulation is a unilateral sacral nerve (S3) stimulation (InterStim device; Medtronic, Inc., Minneapolis, MN). Neuromodulation has been approved by the Food and Drug Administration for treatment of urge incontinence, urinary retention, idiopathic urgency-frequency syndrome, and recently for IC.53 Application of the InterStim device to IC patients has recently been shown to improve symptoms including urinary frequency, urgency, and pain.54 In addition, abnormally high urine APF and abnormally low heparin-binding epidermal growth factor concentrations have been normalized after neuromodula-tion.55 The procedure is performed in two stages, the first stage involving the percutaneous placement of a temporary electrode within the S3 foramen. Appropriate stimulation is then achieved through an external stimulator. If satisfactory symptom improvement occurs, the patient will be a candidate for permanent implantation of a small stimulator (InterStim) unit that rests in the upper buttocks.

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