Sacral neurostimulation for urinary retention: 10-year experience from one UK centre (original) (raw)
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Long-Term Results of Sacral Neuromodulation for Women With Urinary Retention
BJU …, 2004
There were 20 patients (77%) still voiding spontaneously at the time of review (with two having deactivated their stimulator because of pregnancy). Fourteen patients (54%) required revision surgery, and the most common complications included loss of efficacy, implant-related discomfort and leg pain. The mean postvoid residual volume was 75 mL and mean maximum flow rate 20.8 mL/s.
The Journal of …, 2007
Purpose: This 5-year, prospective, multicenter trial evaluated the long-term safety and efficacy of sacral neuromodulation in patients with refractory urge incontinence, urgency frequency and retention. Materials and Methods: A total of 17 centers worldwide enrolled 163 patients (87% female). Following test stimulation 11 patients declined implantation and 152 underwent implantation using InterStim ® . Of those treated with implantation 96 (63.2%) had urge incontinence, 25 (16.4%) had urgency frequency and 31 (20.4%) had retention. Voiding diaries were collected annually for 5 years. Clinical success was defined as 50% or greater improvement from baseline in primary voiding diary variable(s). Results: Data for all implanted cases were reported. For patients with urge incontinence mean leaking episodes per day decreased from 9.6 Ϯ 6.0 to 3.9 Ϯ 4.0 at 5 years. For patients with urgency frequency mean voids per day decreased from 19.3 Ϯ 7.0 to 14.8 Ϯ 7.6, and mean volume voided per void increased from 92.3 Ϯ 52.8 to 165.2 Ϯ 147.7 ml. For patients with retention the mean volume per catheterization decreased from 379.9 Ϯ 183.8 to 109.2 Ϯ 184.3 ml, and the mean number of catheterizations decreased from 5.3 Ϯ 2.8 to 1.9 Ϯ 2.8. All changes were statistically significant (p Ͻ0.001). No life threatening or irreversible adverse events occurred. In 102 patients 279 device or therapy related adverse events were observed. At 5 years after implantation 68% of patients with urge incontinence, 56% with urgency frequency and 71% with retention had successful outcomes. Conclusions: This long-term study demonstrates that InterStim therapy is safe and effective for restoring voiding in appropriately selected cases refractory to other forms of treatment.
Predictive factors for Sacral Neuromodulation outcome in Non-Obstructive Urinary Retention
Neurourology and Urodynamics, 2010
Hypothesis / aims of study: Non-obstructive urinary retention presents as urologically challenging condition, those patients usually depend on clean intermittent catheterization (CIC) or indwelling catheters to empty their bladders. This approach of treatment increases risk of recurrent urinary infections, trauma, and may affect the quality of life of those patients. Sacral Neuromodulation (SNM) has been shown to restore voiding functions in patients suffering from idiopathic urinary retention; InterStim® therapy was approved by FDA in 1999 as treatment modality for non-obstructive urinary retention. SNM is conducted in two steps; First step is called percutaneous nerve evaluation (PNE), then implantation of implantable pulse generator (IPG), second step, which is only reserved for patients who show 50% or more improvement in their voiding dysfunction parameters. The success of SNM in treating non-obstructive urinary retention has been reported in the range of 30-60%; this range has...
Urodynamic evaluation of sacral neuromodulation for urge urinary incontinence
Bju International, 2008
OBJECTIVETo evaluate the urodynamic data before and 6 months after implantation of sacral neuromodulation (SNM, an established treatment for voiding dysfunction, including refractory urge urinary incontinence, UI) and to assess the correlation between the urodynamic data and clinical efficacy in patients with UI.To evaluate the urodynamic data before and 6 months after implantation of sacral neuromodulation (SNM, an established treatment for voiding dysfunction, including refractory urge urinary incontinence, UI) and to assess the correlation between the urodynamic data and clinical efficacy in patients with UI.PATIENTS AND METHODSIn all, 111 patients with a >50% reduction in UI symptoms during a percutaneous nerve evaluation test qualified for surgical implantation of SNM. Patients were categorized in two subgroups, i.e. those with UI with or without confirmed detrusor overactivity (DO) at baseline. At the 6-month follow-up all patients had a second urodynamic investigation, with the stimulator switched on.In all, 111 patients with a >50% reduction in UI symptoms during a percutaneous nerve evaluation test qualified for surgical implantation of SNM. Patients were categorized in two subgroups, i.e. those with UI with or without confirmed detrusor overactivity (DO) at baseline. At the 6-month follow-up all patients had a second urodynamic investigation, with the stimulator switched on.RESULTSAt baseline, there was urodynamically confirmed DO in 67 patients, while 44 showed no DO. A review of filling cystometry variables showed a statistically significant improvement in bladder volumes at first sensation of filling (FSF) and at maximum fill volume (MFV) before voiding for both UI subgroups, compared with baseline. In 51% of the patients with UI and DO at baseline, the DO resolved during the follow-up. However, those patients were no more clinically successful than those who still had DO (P = 0.73). At the 6-month follow-up, 55 of 84 implanted patients showed clinical benefit, having a ≥50% improvement in primary voiding diary variables. Patients with UI but no DO had a higher rate of clinical success (73%) than patients with UI and DO (61%), but the difference was not statistically significant.At baseline, there was urodynamically confirmed DO in 67 patients, while 44 showed no DO. A review of filling cystometry variables showed a statistically significant improvement in bladder volumes at first sensation of filling (FSF) and at maximum fill volume (MFV) before voiding for both UI subgroups, compared with baseline. In 51% of the patients with UI and DO at baseline, the DO resolved during the follow-up. However, those patients were no more clinically successful than those who still had DO (P = 0.73). At the 6-month follow-up, 55 of 84 implanted patients showed clinical benefit, having a ≥50% improvement in primary voiding diary variables. Patients with UI but no DO had a higher rate of clinical success (73%) than patients with UI and DO (61%), but the difference was not statistically significant.CONCLUSIONThese urodynamic results show a statistically significant improvement in FSF and MFV in patients with UI with or with no DO after SNM. Although there was a urodynamic and clinical improvement in both groups, patients with UI but no DO are at least as successful as patients with UI and DO. Therefore in patients with UI, DO should not be a prerequisite selection criterion for using SNM.These urodynamic results show a statistically significant improvement in FSF and MFV in patients with UI with or with no DO after SNM. Although there was a urodynamic and clinical improvement in both groups, patients with UI but no DO are at least as successful as patients with UI and DO. Therefore in patients with UI, DO should not be a prerequisite selection criterion for using SNM.
The Journal of Urology, 2011
Purpose: Few reports address the reoperation rate after sacral neuromodulation implants. We report our long-term results and reoperations during our 14-year experience with sacral neuromodulation at our center. Materials and Methods: We retrospectively reviewed the patient database at our center to assess the long-term outcome, incidence and cause of surgical reintervention after InterStim® sacral neuromodulation implantation for lower urinary tract dysfunction between 1994 and 2008. Results: A total of 96 sacral neuromodulation devices were implanted in 88 women and 8 men. Indications for implantation were bladder pain syndrome in 47.9% of cases, urgency urinary incontinence in 35.4% and idiopathic urinary retention in 16.7%. The explantation rate was 20.8% and median time to removal was 18.5 months. Reasons for explantation in all subgroups were poor result in 12 patients, painful stimulation in 6 and radiation of stimulation to the leg in 2. Median long-term followup was 50.7 months. The longterm success rate was 87.5%, 84.8% and 73% in patients with idiopathic urinary retention, urgency urinary incontinence and bladder pain syndrome, respectively. Overall 39% of patients needed revision of the sacral neuromodulation implant. The main reason for revision was loss of stimulation in 58.5% of cases. The revision rate decreased with the introduction of the tined lead technique from 50% using lead Model 3092 to 31% using lead Model 3893 (Medtronic, Minneapolis, Minnesota). The battery was changed in 8 patients. Mean battery life was 101.8 months. Conclusions: Sacral neuromodulation is a minimally invasive procedure with a good long-term outcome. The reoperation rate has improved with advances in surgical technique and equipment. Abbreviations and Acronyms BPS ϭ bladder pain syndrome FDA ϭ Food and Drug Administration GRA ϭ global response assessment scale IPG ϭ implanted pulse generator IUR ϭ idiopathic urinary retention PNE ϭ percutaneous nerve evaluation SNM ϭ sacral neuromodulation UUI ϭ urgency urinary incontinence
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.
Spinal Cord, 2013
Objectives: To compare the efficacy of intravesical electrostimulation (IVES) versus sacral neuromodulation (SNM) in patients with incomplete spinal cord lesions (SCL) and neurogenic non-obstructive urinary retention (N-NOR). Methods: In this retrospective study, 77 N-NOR patients underwent IVES (minimum 28 sessions), then after returning to voiding baseline symptoms, percutaneous first stage of SNM (lasting for minimum 4 weeks). After the two neuromodulation treatments, responders were categorized as patients experiencing both a 50% reduction of volume per catheterization per ml and a 50% reduction in number of catheterizations per day when comparing the 7-day voiding diaries at the end of both procedures to baselines. New urodynamics were performed subsequently. Responders to first stage of SNM underwent permanent SNM. Results: Forty-eight patients responded to neither of the treatments, whereas 29 responded to both IVES and first-stage SNM. No significant statistical differences (P40.05) were detected in the voiding diaries. Following the two procedures, the first sensation of bladder filling was either maintained or recovered by all responders, whereas the same 11 patients reached a bladder contractility index of 4100. The 29 IVES responders lost their clinical benefits in a mean follow-up of 9.6 months. Only 10 out of the 29 patients became nonresponsive to permanent SNM, in a mean follow-up of 54 months. Conclusion: A strict correlation in terms of clinical and urodynamic patterns was demonstrated in patients with incomplete SCL and N-NOR, following IVES and first stage of SNM. However, voiding improvement through IVES was short-term when compared with the effects of permanent SNM.
Sacral neuromodulation for intractable urge incontinence: Are there factors associated with cure?
Urology, 2005
Objectives. To determine the variables that affect the cure rate in patients with urge incontinence treated with sacral neuromodulation. Methods. This prospective analysis of patients with refractory urinary urge incontinence who underwent placement of a neuromodulator lead and generator was undertaken between October 2000 and December 2003. Quantitative assessment of the severity of their urinary leakage was assessed by preoperative and postoperative 3-day bladder diaries documenting leakage episodes, number of pads used per day, and a 24-hour pad weight assessment. Cure was defined as no daily leakage episodes after permanent implantation. Subjective outcome was assessed using the Incontinence Impact Questionnaire. Two-sample independent t tests, two-way chi-square tests, and tests of two proportions were performed when appropriate, with P Ͻ0.05 considered significant. Results. The mean postimplantation follow-up was 29 months, and the average age was 60 years (range 29 to 83). The cure rate was associated with age, with individuals younger than 55 years having a statistically significant greater cure rate (65% versus 37% for older individuals; P Ͻ0.05). Having three or more chronic conditions was associated with a lower cure rate in both younger and older individuals. Patients with a neurologic condition also had a lower cure rate, but no specific neurologic condition was associated. Conclusions. Age older than 55 years and more than three chronic conditions were independent factors associated with a lower cure rate in patients implanted with a sacral neuromodulator for refractory urge incontinence. A neurologic condition may be associated with a decrease in the cure rate.
Sacral neuromodulation for lower urinary tract dysfunction
World Journal of Urology, 2011
Objectives To review the technique, indications, results and working mechanisms of sacral neuromodulation (SNM) for lower urinary tract dysfunction. Methods The available literature on SNM for lower urinary tract dysfunction was searched. Based on the information available in the literature and also based on personal experience, the urological indications, technique, mechanisms of action and results of SNM are presented and discussed. Results SNM for lower urinary tract dysfunction involves stimulation of the 3rd sacral nerve with an electrode implanted in the sacral foramen and connected to a pulse generator. The technique is accepted by the FDA since 1997. Currently, SNM for lower urinary tract dysfunction has been successfully used in about 26,000 patients with various forms of lower urinary tract dysfunction, including urgency, frequency and urgency incontinence as well as non-obstructive urinary retention. The actual procedure of SNM consists of a minimal invasive technique and is effective in about 70% of the patients who have been implanted with a permanent system. Also, in pelvic pain, interesting results have been described. SNM modulates the micturition reflexes at different levels in the central nervous system. Conclusions Sacral neuromodulation is a safe and effective therapy for various forms of lower urinary tract dysfunction, including urgency, frequency and urgency incontinence as well as non-obstructive urinary retention. It should be the first choice after failure of maximal conservative therapy.