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Sacral neuromodulation (SNM) is an effective and increasingly used therapeutic option for refractory urge incontinence, chronic urinary retention and symptoms of urgency-frequency. The potential for neuromodulation has also been shown in patients with interstitial cystitis and neurogenic urge incontinence secondary to refractory detrusor hyperreflexia. With the increasing number of patients, obvious concerns and challenges raised. Young female patients who desire to conceive showed concerns pertaining to neuromodulation in pregnancy including possible teratogenic effect, symptom management during pregnancy & the effect of mode of delivery on the Sacral electrode. Another concern is the need for MRI follow up in neurogenic patients. Post operative troubleshooting raises another challenge in patient management. In our chapter, we will discuss these challenges in details.

Interest in the definition and management of premature ejaculation (PE) has been increasing significantly among all healthcare professionals and its clinical perceptions continue to evolve in recent years. Accumulating evidence suggests that it is considered to be the most common male sexual disorder (Metz & Pryor, 2000). Obtaining a universally accepted definition for PE has been problematic. Nevertheless, all definitions to date have repeatedly included two basic components which are the inability to control or delay ejaculation, and the resultant distress to one or both partners. Based on these components, the currently accepted definitions have been reported by a number of authorities which are authoritybased rather than evidence-based (Table 1). In addition, PE can be divided into primary, that begins when the patient becomes sexually active, and secondary, which by definition is acquired later in life (Godpodinoff, 1989). Further subdivisions include global PE presenting in all circumstances, versus situational PE which occurs only with certain partners and situations (Donatucci, 2006). Intravaginal ejaculatory latency time (IELT) refers to the time between vaginal penetration and ejaculation, usually measured with a stopwatch or simply estimated in retrospect (Payne & Sadovsky, 2007). There has been no widely accepted standard for ‘normal’ IELT. In 2005, Patrick et al. found on a large community-based population of men and their partners that the median IELT, recorded using a partner-held stopwatch, was 7.3 min for men without PE, whereas men with PE had a median IELT of 1.8 min (Patrick et al., 2005). A multinational population survey of IELT by Waldinger et al. showed that 90% of 110 men with self-reported lifelong PE had an IELT of less than 60 seconds (Waldinger et al., 2005). IELT of less than 2 minutes is generally accepted as defining PE (Waldinger et al, 1998). A small percentage of men will ejaculate even before penetration. Others have advocated not to define the disorder with a specific time duration and instead suggested that a diagnosis is made when the man ejaculates too early for female partner satisfaction in greater than one-half of encounters (Masters & Johnson, 1970).