Sacral neuromodulation for lower urinary tract dysfunction (original) (raw)
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Sacral Nerve Stimulation for Neuromodulation of the Lower Urinary Tract
Springer eBooks, 2009
Patients with symptoms of overactive bladder syndrome or non-obstructive urinary retention, refractory to conservative therapy, can nowadays be treated minimally invasively with sacral nerve stimulation (SNS). The use of electric currents to treat urological pathology has a long history but SNS therapy only received FDA approval in 1997. The mechanisms of action are still not known so there are different theories explaining the modulation effect. Recent studies have shown a central modulation effect. Predictive factors which can help to identify the perfect candidates are not known. Over the years the technique of SNS has become less invasive and because of two stage implantation test results have proven to be more reliable. The clinical results for this therapy have proven to be safe and effective and with the technical improvements over the years the re-operation and complication rates have decreased significantly. The clinical results have led to expanding indications because of positive effects in other symptoms. In the field of urology this has resulted in the use of SNS therapy for interstitial cystitis, neurogenic lower urinary dysfunction, and pediatric voiding dysfunction. In the field of gastro-intestinal pathology, SNS therapy is used to treat faecal incontinence and constipation.
International braz j urol : official journal of the Brazilian Society of Urology
We report on the short-term outcomes of sacral neuromodulation (SNM) for treatment of idiopathic lower urinary tract dysfunction in Brazil (procedures performed before 2014). Clinical data and surgical outcomes of patients who underwent SNM staged procedures were retrospective evaluated. Urological assessment included a focused medical history and physical examination, measurement of postvoid residual volumes, urodynamics, and bladder diaries. A successful test phase has been defined by improvement of at least 50% of the symptoms, based on bladder diaries. From January 2011 to December 2013, eighteen consecutive patients underwent test phase for SNM due to refractory overactive bladder (15 patients), non-obstructive chronic urinary retention (2 patients), and bladder pain syndrome/interstitial cystitis (1 patient). All patients underwent staged procedures at four outpatient surgical centers. Mean age was 48.3±21.2 (range 10-84 years). There were 16 women and 2 men. Median follow-up ...
Efficacy of sacral neuromodulation for symptomatic treatment of refractory urinary urge incontinence
Urology, 2006
Objectives. To determine the efficacy and complications of sacral neuromodulation as therapy for refractory urinary urge incontinence. Methods. Forty-one patients (mean age 54.3 Ϯ 15.8 years) with urge incontinence refractory to conservative therapy (ie, pharmacologic, behavioral, biofeedback therapy) were retrospectively evaluated. The patients included those who received permanent one-staged or two-staged InterStim implants. Surgical implantation of the InterStim was performed in patients who experienced a greater than 50% reduction in urge incontinence symptoms, as documented by voiding diaries during a 3 to 7-day test stimulation period. Results. Ninety percent of patients had 50% or greater improvement in presenting symptoms and qualityof-life parameters after InterStim implantation, with a median follow-up of 12 months (interquartile range 12 to 26.5) for single-stage and 4.5 months (interquartile range 1.5 to 12) for staged implants (P ϭ 0.0003 Wilcoxon rank-sum test). Patients with urge incontinence had a significant reduction in mean leaking episodes (from 8.8 to 2.3 per day, P ϭ 0.0001), with a significant decrease in the mean number of pads used (from 4.7 to 0.82 per day, P Ͻ0.0001). No patient experienced operative complications, and postoperative complications were encountered in 29% of patients. Conclusions. Our results have demonstrated that sacral neuromodulation is a safe and effective approach for the treatment of urinary urge incontinence that is refractory to other more conservative forms of treatment.
Advances in the role of sacral nerve neuromodulation in lower urinary tract symptoms
International Urogynecology Journal, 2010
Sacral neuromodulation has been developed to treat chronic lower urinary tract symptoms, resistant to classical conservative therapy. The suspected mechanisms of action include afferent stimulation of the central nervous system and modulation of activity at the level of the brain. Typical neuromodulation is indicated both in overactivity and in underactivity of the lower urinary tract. In the majority of patients, a unilateral electrode in a sacral foramen and connected to a pulse generator is sufficient to achieve significant clinical results also on long term. In recent years, other urological indications have been explored.
Italian Journal of Gynaecology and Obstetrics
Objective. Sacral neuromodulation (SNM) is a technique that electrically stimulates the third sacral spinal nerve root to modulate a neural pathway. In this study, we present our 7-years' experience outcomes and complications of SNM in lower urinary tract dysfunctions. Materials and Methods. We performed a single-center retrospective cohort study of all patients who underwent InterStim Medtronic SNM device implantation for lower urinary tract dysfunction. All procedures were performed between January 2014 and November 2021 in the Urogynecologycal Center of Villa Sofia Hospital in Palermo by a single expert team. We included 68 patients with refractory lower urinary tract dysfunction who did not adequately respond to primary therapeutical strategies. Results. We observed a reduction rate of catheterization from a mean of 4.05 to 1.22. In addition, the amount of post-voidal residual decreased from a mean of 520 ml to 187 ml. Among the 41 women in the overactive bladder group, only 36 were included in the follow-up; 24 of the 36 patients (66.6%) had no episodes of leaks; the remaining patients (33.4%) had a significant reduction of leaks. We also recorded a significant reduction in urinary frequency: voids per day decreased from 16.1 at baseline to 6.1. Among the 7 women with BPS, only 5 patients (71.42%) completed the follow-up protocol. They reported satisfaction from the treatment: no patients chronically used pain drugs, and only 1 used occasionally painkillers. Conclusions. SNM treatment has been found as a potential effective and feasible option for urogynecologycal disorders.
BMC Urology, 2014
Background: Sacral neuromodulation has become a well-established and widely accepted treatment for refractory non-neurogenic lower urinary tract dysfunction, but its value in patients with a neurological cause is unclear. Although there is evidence indicating that sacral neuromodulation may be effective and safe for treating neurogenic lower urinary tract dysfunction, the number of investigated patients is low and there is a lack of randomized controlled trials. Methods and design: This study is a prospective, randomized, placebo-controlled, double-blind multicenter trial including 4 sacral neuromodulation referral centers in Switzerland. Patients with refractory neurogenic lower urinary tract dysfunction are enrolled. After minimally invasive bilateral tined lead placement into the sacral foramina S3 and/or S4, patients undergo prolonged sacral neuromodulation testing for 3-6 weeks. In case of successful (defined as improvement of at least 50% in key bladder diary variables (i.e. number of voids and/or number of leakages, post void residual) compared to baseline values) prolonged sacral neuromodulation testing, the neuromodulator is implanted in the upper buttock. After a 2 months post-implantation phase when the neuromodulator is turned ON to optimize the effectiveness of neuromodulation using sub-sensory threshold stimulation, the patients are randomized in a 1:1 allocation in sacral neuromodulation ON or OFF. At the end of the 2 months double-blind sacral neuromodulation phase, the patients have a neuro-urological re-evaluation, unblinding takes place, and the neuromodulator is turned ON in all patients. The primary outcome measure is success of sacral neuromodulation, secondary outcome measures are adverse events, urodynamic parameters, questionnaires, and costs of sacral neuromodulation. Discussion: It is of utmost importance to know whether the minimally invasive and completely reversible sacral neuromodulation would be a valuable treatment option for patients with refractory neurogenic lower urinary tract dysfunction. If this type of treatment is effective in the neurological population, it would revolutionize the management of neurogenic lower urinary tract dysfunction.
Neuromodulation: Technology at the Neural Interface, 2000
Objectives. Sacral nerve stimulation (SNS) (Medtronic, pathways in the spinal cord. Hyperactive voiding can be suppressed by direct inhibition of bladder preganglionic Inc., Minneapolis, MN) is an exciting new treatment for refractory voiding disorders including urinary inconti-neurons as well as inhibition of interneuroneal transmission in the afferent limb of the micturition reflex. On the nence, retention, and voiding dysfunction. It is known that both voiding and continence reflex mechanisms other hand, voiding in patients with urinary retention can be facilitated by inhibition of reflex pathways to the are organized in the sacral spinal cord and that pathologic conditions can alter the balance between these urethral outlet (guarding reflexes).
Journal of Urology, 1994
Chronic lower urinary tract dysfunction can be treated by sacral neuro-stimulation. Clinical parameters for selection of patients for this expensive and invasive treatment modality are not well defined to date. Therefore, before implantation of a permanent stimulator, the effect is tested by temporary implantation of a wire electrode connected to an external stimulator. According to the literature, many patients do not respond during temporary implantation and a mean of 25% of the patients with a permanent stimulator implanted fail to respond as well. To improve patient selection, we attempted to define clinical parameters to predict the outcome of sacral neurostimulation in 100 consecutive patients who were tested with temporary sacral stimulation. A total of 34 patients achieved a complete cure on trial stimulation. It appeared that detrusor overactivity and urethral instability responded best but they were not predictors of success. We conclude that neither gender, patient age, history nor diagnosis are predictors of success in sacral neuro-stimulation of lower urinary tract dysfunction.