Overactive bladder syndrome and voiding dysfunction are very bothersome lower urinary tract symptoms. Treatment of overactive bladder symptoms starts with conservative and medical therapy including fluid manipulation, bladder retraining, antimuscarinics and mirabegron. For voiding dysfunction, treatment is usually by self-catheterisation if patients have high residuals. However a large proportion of patients suffer in silence if these treatments don’t work or they suffer side effects. For refractory overactive bladder syndrome, Botulinum toxin-A injection (BOTOX) into the bladder or sacral neuromodulation (SNM) are the next steps in treatment. Both have been given a Grade A/Strong recommendation by the European Association of Urology guidelines. SNM helps with several pelvic floor disorders and therefore can also be used to treat voiding dysfunction. Sacral neuromodulation has been used since the early 1980s, however the last year has seen newer technological advances which meant patients who previously were not eligible to have this treatment are now able to.