الفهرس 
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Abstract
Chronic urinary retention is defined as non-painful bladder which remains palpable after the patient has passed urine. It is due to gradual accumulation of residual urine resulting from detrusor underactivity. chronic urinary retention can be caused by obstructive or non-obstructive causes. The treatment of obstructive causes is by surgery. Non-obstructive chronic urinary retention is changeling and may be complicated by serious problems. Sacral neuromodulation was introduced as a novel therapy and second line treatment for those patients.
In the first chapter of this thesis, we gave a brief review about the anatomy and histology of lower urinary tract innervation and functions. We explained the causes and pathogenesis of chronic urinary retention. We also explored the history of sacral neuromodulation, its efficacy and the possible mechanisms of action.
In the second chapter, we explained how we recruited our patients, items to be studies and the statistical tests used. In the third chapter, we studied the efficacy of sacral neuromodulation in treating patients with chronic urinary retention by comparing the results of their voiding parameters before and after the treatment. We found that it was successful in treating 81% of our patients. Moreover, sacral neuromodulation has good impact on improving their quality of life. In addition, we took bladder biopsies from a small subgroup of our patients to study the changes in their suburothelial nerves before and after sacral neuromodulation. We found that the number of nerves and nerve ending in each nerve bundle increased after treatment. There was also rise in the number of small and large vesicles responsible for motor and sensory function. Moreover, the nerves degeneration decreased and nerve regeneration improved after treatment. In the fourth chapter, we explained the possible causes of our results, compared them to the literature and drawn some conclusions that can explain the possible mechanism of action of sacral neuromodulation.