Efficacy of sacral neuromodulation for symptomatic treatment of refractory urinary urge incontinence (original) (raw)
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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.
Effects of Sacral Neuromodulation on Urinary and Fecal Incontinence
2015
BACKGROUND Fecal incontinence is defined as involuntary passage of stool through the anus. It may vary from soiling to complete evacuation. This involuntary loss of feces, flatus or urge incontinence adversely affects quality of life. Urinary urge incontinence is characterized by symptoms of frequency, urgency and urge incontinence (either alone or in combination). Urgency frequency syndrome is defined as symptoms of frequency and urgency without incontinence episodes. OBJECTIVES To evaluate the efficacy of sacral neuromodulation on these pathologies. METHODS Following a detailed investigation, 51 patients with either urinary or fecal incontinence, or both, who did not respond to medical and behavioral treatment were offered the temporary implant. Of the 51 patients 40 showed improvement and advanced for a permanent device. RESULTS After a mean follow-up of 5 years (range 1-8), there was a significant reduction in the number of incontinence episodes (P < 0.0001), and the number o...
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.
American Journal of Obstetrics and Gynecology, 2005
This study was undertaken to evaluate the response to sacral neuromodulation in women with refractory, nonobstructive urinary urge incontinence after stress incontinence surgery. Study design: We reviewed the medical records of women in whom sacral neuromodulation was performed for worsening or de novo urinary urge incontinence after a stress incontinence procedure. All patients had undergone preliminary test stimulation. Demographics, surgical and urogynecologic history, including bladder diary and pad weight test, and urodynamic parameters were evaluated. Results: Of 34 women, 22 (65%) responded to the test stimulation and underwent permanent lead implant. There was no difference between responders and nonresponders with respect to type of stress incontinence surgery. Incontinence or urodynamic parameters were not different between responders and nonresponders. Factors that were predictive of a positive response were women aged less than 55 years (P = .01), the test stimulation performed within 4 years of the stress incontinence procedure (P = .01), and evidence of pelvic floor muscle activity (P = .03). Conclusion: Sacral neuromodulation is a viable option for the treatment of refractory urinary urge incontinence that occurs after stress urinary incontinence surgery. Older women with no pelvic floor activity who are remote from their incontinence surgery may have a suboptimal response.
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.
Sacral neuromodulation in an older, urge-incontinent population. Discussion
American Journal of Obstetrics and Gynecology, 2002
Durham, NC OBJECTIVE: The success of sacral neuromodulation in the treatment of urge incontinence has been reported in young populations. Herein we report the success in an older, urge-incontinent population. STUDY DESIGN: A cohort of 25 patients older than 55 years who had failed conventional therapy for the treatment of urge incontinence underwent percutaneous S3 sacral nerve test stimulation. Patients were considered candidates for permanent implantation if they were cured or had a greater than 50% improvement in incontinent episodes. Responders were implanted and completed a questionnaire, bladder diary, and disease-specific quality-of-life questionnaire. RESULTS: Twelve of the 25 patients (48%) responded to the test stimulation. The average follow-up after permanent implantation was 7.8 months. All patients obtained a >50% reduction in their incontinent episodes; 2 patients achieved total dryness. CONCLUSION: Our small cohort suggests that older urge-incontinent patients have improvement with sacral neuromodulation but cure rates may be lower than with a younger population.
Sacral neuromodulation in an older, urge-incontinent population
American Journal of Obstetrics and Gynecology, 2002
Durham, NC OBJECTIVE: The success of sacral neuromodulation in the treatment of urge incontinence has been reported in young populations. Herein we report the success in an older, urge-incontinent population. STUDY DESIGN: A cohort of 25 patients older than 55 years who had failed conventional therapy for the treatment of urge incontinence underwent percutaneous S3 sacral nerve test stimulation. Patients were considered candidates for permanent implantation if they were cured or had a greater than 50% improvement in incontinent episodes. Responders were implanted and completed a questionnaire, bladder diary, and disease-specific quality-of-life questionnaire. RESULTS: Twelve of the 25 patients (48%) responded to the test stimulation. The average follow-up after permanent implantation was 7.8 months. All patients obtained a >50% reduction in their incontinent episodes; 2 patients achieved total dryness. CONCLUSION: Our small cohort suggests that older urge-incontinent patients have improvement with sacral neuromodulation but cure rates may be lower than with a younger population.
Fecal incontinence treated by sacral neuromodulation: Long-term follow-up of 325 patients
Surgery, 2017
Background. Long-term results of large patient cohorts with fecal incontinence treated by sacral neuromodulation are limited. This study shows the long-term results after a mean follow-up of 7.1 years in 325 patients with fecal incontinence treated by continuous sacral neuromodulation. Methods. All patients with fecal incontinence and eligible for sacral neuromodulation between 2000 and 2015 were evaluated retrospectively. Primary outcome was a decrease in episodes of fecal incontinence, which was defined as involuntary fecal loss at least once per week and documented by a 3 week bowel habit diary. Quality of life was assessed using the Short-Form 36 and the Fecal Incontinence Quality of Life Score. Results. In the study, 374 patients were included for sacral neuromodulation screening and 325 patients (32 male, 9.7%) received permanent, continuous sacral neuromodulation. Mean age was 56.5 years (17-82 years) and mean follow-up was 7.1 years (3.0-183.4 months). In the 325 patients with permanent sacral neuromodulation, fecal incontinence episodes decreased from a mean of 16.1 ± 14.5 to 3.0 ± 3.7 per 3-week period after sacral neuromodulation (P < .001) according to the bowel habit diary. Sacral neuromodulation was removed due to unsatisfactory results in 81 patients. Quality of life (both Short-Form 36 and Fecal Incontinence Quality of Life Score) showed no significant difference compared with the Dutch population during follow-up. Conclusion. Long-term efficacy of sacral neuromodulation can be maintained in about half (52.7%) of all patients screened with sacral neuromodulation for fecal incontinence after a mean follow-up of 7.1 years. Importantly, the quality of life of patients with sacral neuromodulation for fecal incontinence did not differ from the general population. (Surgery 2016;j:j-j.
Is sacral neuromodulation here to stay? Clinical outcomes of a new treatment for fecal incontinence
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2015
Sacral neuromodulation (SNM) was approved by the FDA for the treatment of fecal incontinence (FI) in 2011, and previous industry-sponsored trials have shown excellent clinical outcomes. The purpose of this study is to examine clinical outcomes of patients treated during our initial experience with SNM. A prospective database of patients treated with SNM for FI by one of three colorectal surgeons at two separate institutions was maintained starting in 2011. Patients showing ≥50% improvement of weekly incontinent episodes during test stimulation were offered permanent implantation of the SNM device. Disease severity was tracked using the Wexner score. A total of 145 patients received a full system implantation (of 152 who received test stimulation). The median preoperative Wexner score of 14 decreased to 3, 3 months after implantation and persisted to 12 months. At 12 months, 95.2% of patients achieved >50% improvement in Wexner Score and 67.6% achieved >75% improvement. The mos...
Neuromodulation for Fecal and Urinary Incontinence
Diseases of the Colon & Rectum, 2012
BACKGROUND: Sacral nerve stimulation is a recognized treatment for fecal and urinary incontinence. Few articles have been published about patients presenting with both types of incontinence. OBJECTIVE: The aim of this study was to report the functional results in patients operated on for simultaneous fecal and urinary incontinence by the use of sacral nerve stimulation. DESIGN: This study is a retrospective analysis of prospectively collected data. SETTINGS: The investigation was conducted in the academic departments of colorectal surgery and urology.