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Underactive bladder (UAB) is defined as “a symptom complex suggestive of detrusor underactivity and is usually characterized by prolonged urination time with or without a sensation of incomplete bladder emptying, usually with hesitancy, reduced sensation on filling, slow stream, palpable bladder, always straining to void, enuresis, and/or stress incontinence”. Detrusor underactivity (DUA) is the physio-pathological background of UAB and it is defined by the International Continence Society (ICS) as “a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span”. Any alteration of the anatomical structures involved in the bladder physiology can impair the detrusor function and load underactive bladder. Particularly, neurological, metabolic, and functional diseases may cause specific neurological and muscle alterations implicated in the UB physiopathology. When the cause is not clear, UAB can be defined “idiopathic”.

Prostate cancer (PCa) is the most frequently diagnosed solid tumor among men and the third leading cause of cancer-related deaths. This is a multifactorial disease, in which constitutional and environmental risk factors play an essential role in the carcinogenesis process. The screening program for PCa consists in a periodic prostate-specific antigen (PSA) blood test and digital rectal exam (DRE). Therefore, there is a significant risk of over-diagnosis and over-treatments as demonstrated by several clinical trials. Approximately 80% of newly diagnosed PCa is represented by localized disease. Surgery and radiant therapy represent accepted alternatives for the treatment of localized PCa. Randomized trials directly comparing these two approaches still lack. Moreover, for men with low-risk PCa and life expectancy of 10 years or less, active surveillance and watchful-waiting are two observational approaches that have been introduced to delay or avoid curative treatment without compromising long-term cancer-specific survival in a selected population.

Chronic pain in the pelvic region is often associated with lower urinary tract symptoms, bowel problems or sexual dysfunction; contrariwise, symptoms of bladder origin are often accompanied by pelvic pain. Chronic pelvic pain (CPP) is less well defined than bladder, urethral or perineal pain, and is less clearly related to the micturition cycle or to bowel function and is not localized to any single pelvic organ. Much debate over the classification of CPP has occurred, is ongoing and will continue in the future. Classification involves three aspects of defining a condition: phenotyping, terminology and taxonomy. As a result of systematic phenotypic and taxonomic classifications, similarities and differences between conditions become clear. Drawing comparisons between the phenotypes of different disorders allows one to compare disorders such as bladder and bowel pain syndromes, thus facilitating research and treatment. There are insufficient data available on the epidemiology of CPP to design a complete and correct incidence. The prevalence for women in reproductive ages is between 14 and 24% and about 14% of women experience CPP at least for one time during their life. The prevalence of bladder pain syndrome has great variability because of its controversial clinical diagnosis and the method of screening, ranging from 0.06% to 30%. Population-based prevalence of prostatitis symptoms ranges from 1% to 14.2%.

Overactive bladder (OAB), both wet and dry, is a common and widely recognized syndrome, being part of the so-called lower urinary tract dysfunction (LUTD). It causes a spectrum of morbidity and decreased quality of life for patients. The classic treatments of LUTD and OAB comprise different strategies. When patients have tried behavioral modifications and oral medical therapy, without experiencing adequate relief of their symptoms, the next step is to consider minimally invasive therapies. Sacral neuromodulation (SNM), otherwise termed sacral nerve stimulation (SNS), has been approved by the Food and Drug Administration (FDA) for the treatment of refractory voiding dysfunction since the late 1990s, urge incontinence (UI) since 1997, and OAB since 1999 [1].

The lower urinary tract (LUT) consists of urinary bladder, the lower part of both ureters together with the uretero-vesical junction, the urethra and the external urethral sphincter, also referred to as the rhabdosphincter. In men the prostate is considered part of the urethra.