No abstract

RESULTSTen patients had a one-stage and 39 a twostage implant; of the latter group, 31 (80%) had a positive response and eight (21%) did not. In all, 31 patients were included in the follow-up. At the last follow-up, 28 (90%) patients had a > 50% improvement in diary variables and three (10%) did not. In 21 patients with urgency symptoms the mean ( SD ) number of voids decreased from 11.7 (8.9)/day at baseline to 7.3 (3.4)/day ( P = 0.1); the voided volume increased from 160.2 (70.7) mL to 231.1 (119.5) mL ( P = 0.001); and the number of leakages decreased from 9.5 (8.7) to 3.3 (2.2)/day ( P = 0.17). In the 10 patients with retention,

Despite the small sample size, this study indicates that patients who are dissatisfied with or in whom botulinum toxin-A treatment fails can respond successfully to sacral neuromodulation. The success rate of the test stimulation was comparable to that of patients who have never been treated with botulinum toxin-A. The 1-year satisfaction rate was comparable that of patients without a history of botulinum toxin-A treatment.

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.

Possible benefits for patients could be: more autonomy, longer battery life of the implanted INS, decreasing the chance of adaptation by the nervous system.

No abstract

Preliminary results of sacral nerve modulation in a subgroup of spina bifida patients with combined faecal and urinary functional disorders look promising, but long-term results in larger patient groups need to be studied.

Objectives To evaluate the effectiveness of a web‐based decision aid (DA), with values clarification exercises compared with usual care, for men with lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). Patients and Methods Between July 2016 and January 2017, all new patients with LUTS/BPH who consulted the urologist were invited to use the DA and participate in this prospective questionnaire study. Patients who consulted the urologist between December 2015 and February 2016 served as controls. The DA was designed to support patients in making a well‐informed treatment decision, corresponding with their personal preferences and values. Well‐informed decision was measured by using a knowledge questionnaire. Value congruent decision was measured by the correspondence between responses on nine value statements and chosen treatment. The primary outcome, decision quality, was defined as the combination of well‐informed decision and value congruent decision. Secondary outcomes were decisional conflict, involvement and received role in shared decision‐making, decisional regret, and treatment choice. Results A total of 109 DA‐users and 108 controls were included. DA‐users were younger (68.4 vs 71.5 years; P = 0.003) and their education level was higher (P = 0.047) compared with the controls. Patients who used the DA made a well‐informed and value congruent decision more often than the control group (43% vs 21%; P = 0.028). DA‐users had less decisional conflict (score 33.2 vs 46.6; P = 0.003), experienced a less passive role in decision‐making (22% vs 41%; P = 0.038), and reported less process regret (score 2.4 vs 2.8; P = 0.034). Furthermore, DA‐users who had not used prior medication chose lifestyle advices more often than the control group (43% vs 11%; P = 0.002). Outcomes were adjusted for significantly different baseline characteristics. Conclusion The LUTS/BPH DA seems to improve the decision quality by supporting patients in making more well‐informed and value congruent treatment decisions. Therefore, further implementation of this DA into routine care is suggested.