A Prospective Randomized Trial Comparing the 1-Stage with the 2-Stage Implantation of a Pulse Generator in Patients with Pelvic Floor Dysfunction Selected for Sacral Nerve Stimulation

Everaert, Karel; Kerckhaert, Wim; Caluwaerts, Hilde; Audenaert, Mieke; Vereecke, Hugo; Cuypere, Greta De; Boelaert, A; Hombergh, Ubi van den; Oosterlinck, W

doi:10.1016/j.eururo.2003.11.015

Cited by 99 publications

(52 citation statements)

References 20 publications

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“…This is comparable to other studies in the literature that have shown that a staged implant technique improves the test stimulation response by minimizing technical failures, ultimately leading to a higher percentage of patients who have a pulse generator implanted [Scheepens et al, 2002b;Everaert et al, 2004;Kessler et al, 2005]. We utilized a test stimulation period of 7^14 days in our study with satisfactory results.…”

Section: Discussionsupporting

confidence: 80%

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Starkman

Wolter

Scarpero

et al. 2006

Neurourology and Urodynamics

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Aims: We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods: A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: signi¢cant response (80% improvement), moderate response (50% and <80% improvement), and poor response (<50% response). Results: Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal ¢stula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no signi¢cant di¡erences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion: Sacral neuromodulation appears to be an e¡ec-tive therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality. Neurourol. Urodynam. 26: 29^35, 2007. ß 2006

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Section: Discussionsupporting

confidence: 80%

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Starkman

Wolter

Scarpero

et al. 2006

Neurourology and Urodynamics

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“…A study by Everaert et al showed similar findings [25]. In this study, the two-stage procedure was compared with the single-stage procedure.…”

Section: Selecting Patients For Snssupporting

confidence: 67%

Advances in the role of sacral nerve neuromodulation in lower urinary tract symptoms

Kerrebroeck

2010

Int Urogynecol J

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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.

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“…Psychological testing or psychiatric evaluation in case of doubt was advised before implantation of a permanent system. A study by Everaert et al 32 showed similar findings. In this study the two-stage procedure was compared with the singlestage procedure.…”

Section: Selecting Patients For Snsmentioning

confidence: 54%

Sacral nerve stimulation for neuromodulation of the lower urinary tract

Oerlemans

Kerrebroeck

2007

Neurourology and Urodynamics

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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.

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A Prospective Randomized Trial Comparing the 1-Stage with the 2-Stage Implantation of a Pulse Generator in Patients with Pelvic Floor Dysfunction Selected for Sacral Nerve Stimulation

Cited by 99 publications

References 20 publications

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Advances in the role of sacral nerve neuromodulation in lower urinary tract symptoms

Sacral nerve stimulation for neuromodulation of the lower urinary tract

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