Charles Powell, MD, on GLP-1 use and sacral neuromodulation outcomes

In the following video, Charles R. Powell, MD, discusses how the rise of GLP-1–associated weight loss may reshape outcomes and device management in sacral neuromodulation. Powell is an associate professor of urology at Indiana University School of Medicine in Indianapolis.

Powell explained that GLP-1 therapies are producing meaningful and sustained weight loss at approximately 15% in clinical trials, which can positively influence lower urinary tract symptoms. While the most pronounced improvements are seen in stress urinary incontinence, patients with overactive bladder may also experience incremental benefit. In patients already undergoing sacral neuromodulation, this weight reduction could enhance therapeutic outcomes, potentially amplifying symptom control when these modalities are combined in practice.

However, Powell noted a potential unintended consequence: significant loss of adipose tissue in the gluteal region may alter the positioning and tolerability of implanted neuromodulation devices. He emphasized that roughly one-third of sacral neuromodulation systems already require revision, often due to issues with the implanted battery or generator pocket. Anecdotally, he said clinicians are observing that weight loss may bring these devices closer to the skin surface, increasing discomfort or device migration and potentially driving higher revision rates.

Looking ahead, Powell highlighted emerging innovations designed to address these challenges, including a next-generation sacral neuromodulation system currently under investigation that eliminates the need for an implanted battery. This technology uses wireless energy transfer through tissue to power the device, potentially reducing complications associated with generator pockets. By removing the need for surgical battery replacement and minimizing revision risk, such advancements could be particularly valuable in an era where GLP-1–driven weight loss is becoming increasingly common among urologic patients.