Clinical Outcomes of Sacral Neuromodulation in Patients With Neurologic Conditions

Peters, Kenneth M.; Kandagatla, Pridvi; Killinger, Kim A.; Wolfert, Cheryl; Boura, Judith

doi:10.1016/j.urology.2012.11.073

Cited by 77 publications

(63 citation statements)

References 12 publications

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“…[4][5][6][7][8][9] The mechanism of action is not entirely clear; however, inhibition of afferent signals presumably interrupts inappropriate detrusor contractions. 18,19 Although originally not thought to be a promising treatment option for patients with neurogenic bladder disorders, more recent studies suggest that these patients can benefit from SNM and up to 68% of patients in the test phase and 92% of patients in the permanent SNM phase can be successfully treated; 10,11 we report similar success rates (56.5 and 92.3%, respectively). Patients with spinal cord disease or injury often suffer not only from LUTD, but also from bowel dysfunction.…”

Section: Discussionsupporting

confidence: 61%

“…Because SNM may be beneficial for both conditions, patients with combined dysfunction are good candidates for SNM, which can have a high impact on the associated quality of life. 10,11 In our group, all the patients had multiple symptoms. In these patients, SNM may only have had an effect on one or two symptoms, but if quality of life could be improved, an implant may be indicated, even if not all symptoms are improved.…”

Section: Discussionmentioning

confidence: 63%

“…5,[7][8][9] Originally, SNM was not considered as an option for neurogenic lower urinary tract dysfunction (LUTD); however, some studies now suggest that SNM is also effective in this group of patients. 10,11 The aim of this retrospective study was to assess the clinical effects of SNM on patients with neurogenic bladder and/or bowel dysfunction who had multiple symptoms secondary to spinal cord disease or injury.…”

Section: Introductionmentioning

confidence: 99%

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Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease

Chen

Liu

2014

Spinal Cord

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Study design: Retrospective case series. Objectives: The primary aim was to assess the clinical effects of sacral neuromodulation (SNM) for neurogenic bladder and/or bowel dysfunction with multiple symptoms secondary to spinal cord disease or injury. Setting: Beijing, China. Methods: Between 2011 and 2013, 23 patients with multiple bladder and/or bowel problems secondary to spinal cord disease or injury were treated with a preliminary test SNM. If at least 50% clinical improvement occurred, then the patient underwent a permanent SNM procedure. We evaluated the patients using a bladder diary, post-void residual volume measurement and the Wexner questionnaire score for constipation before the test phase, during the test phase and after the permanent SNM. Results: In the test phase, the rate of improvement in dysuria (29.4%) was significantly lower than urgency frequency (64.7%), urinary incontinence (69.2%) and constipation (75.0%). An implant was performed in 13 (56.5%) patients, including 4 patients who still used intermittent catheterization to exclude urine after permanent SNM because the symptom of dysuria could not be improved significantly and 1 patient who achieved X50% improvement in lower urinary tract dysfunction but not in constipation. During follow-up (17.5 ± 2.0 months), 1 patient (7.7%) failed and 1 patient had bilateral vesicoureteral reflux. Conclusion: Chronic SNM cannot always resolve all the bladder and bowel symptoms secondary to spinal cord disease or injury, but combined with other treatments may help improve multiple symptoms.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease

Chen

Liu

2014

Spinal Cord

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“…Initially, considered as unsuitable for the treatment of LUT dysfunction in neurological patients due to the impaired neuronal innervation, sacral neuromodulation (SNM) has yet been demonstrated to be a promising treatment option for NDO [58,59]. However, there is a lack of RCTs, and it is unclear which neurological patient is most suitable for SNM [58].…”

Section: Permanent Neuromodulation With Implanted Electrodesmentioning

confidence: 99%

The management of urinary incontinence in the male neurological patient

Mehnert

Kessler

2014

Current Opinion in Urology

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PURPOSE OF REVIEW: Urinary incontinence in male neurological patients is a very frequent problem but treatment remains challenging. Thus, we summarize and highlight the latest developments in the management of urinary incontinence in this specific patient population. RECENT FINDINGS: Intermittent self-catheterization, antimuscarinics, intradetrusor injections with onabotulinumtoxinA, augmentation cystoplasty, urinary diversion, and artificial urinary sphincter are the cornerstones of the armamentarium for treating neurogenic urinary incontinence. However, with the exception of onabotulinumtoxinA intradetrusor injections, level of evidence is often low and male-specific outcomes are virtually not available. Alternative conservative and/or minimally invasive procedures such as neuromodulation techniques and suburethral suspension devices provide promising data with apparently good safety and tolerability but still insufficient evidence lacking randomized control trials. SUMMARY: Standard options for treatment of urinary incontinence in neurological patients remain largely unchanged. Alternative treatment options, especially of conservative or minimally invasive character, have the potential to further broaden the therapeutic spectrum. While a higher level of evidence is needed to assess the potential of such therapeutic approaches, randomized controlled trials in the male neurological population present a challenge. To truly advance treatment of urinary continence in male neurological patients, well-designed, multicenter studies are warranted. Purpose of review Urinary incontinence in male neurological patients is a very frequent problem but treatment remains challenging. Thus, we summarize and highlight the latest developments in the management of urinary incontinence in this specific patient population. Recent findingsIntermittent self-catheterization, antimuscarinics, intradetrusor injections with onabotulinumtoxinA, augmentation cystoplasty, urinary diversion, and artificial urinary sphincter are the cornerstones of the armamentarium for treating neurogenic urinary incontinence. However, with the exception of onabotulinumtoxinA intradetrusor injections, level of evidence is often low and male-specific outcomes are virtually not available. Alternative conservative and/or minimally invasive procedures such as neuromodulation techniques and suburethral suspension devices provide promising data with apparently good safety and tolerability but still insufficient evidence lacking randomized control trials. SummaryStandard options for treatment of urinary incontinence in neurological patients remain largely unchanged. Alternative treatment options, especially of conservative or minimally invasive character, have the potential to further broaden the therapeutic spectrum. While a higher level of evidence is needed to assess the potential of such therapeutic approaches, randomized controlled trials in the male neurological population present a challenge. To truly advance treatment of urinary continence in mal...

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“…2 Although the efficacy and safety of SNM in patients with idiopathic LUT dysfunction has been frequently demonstrated, its effectiveness in patients with NLUTD is not well documented. [7][8][9][10] In particular, there is a lack of clinical studies reporting urodynamic results after SNM.…”

Section: Introductionmentioning

confidence: 99%

Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction

2015

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Study design: This is a retrospective chart analysis. Objectives: The objective of this study was to evaluate the effect of sacral neuromodulation (SNM) in patients with neurogenic lower urinary tract dysfunction (NLUTD). Settings: This study was conducted in a spinal cord injury rehabilitation center in Switzerland. Methods: The charts of all patients who underwent SNM (testing and/or permanent implantation) because of NLUTD at our institution between 2007 and 2013 were evaluated. Treatment outcomes and complications were recorded. Results: A total of 50 patients, 30 women and 20 men, with a mean age of 46 (±14) years, fulfilled the inclusion criteria. The most frequent cause for SNM was spinal cord injury in 35 patients (70%). Median duration of the underlying disease was 9.5 (±9.3) years. In all, 35 patients (70%) received a permanent implant. The complication rate was 16% (8/50). At the last follow-up, SNM was in use in 32 patients. In 26 patients with SNM because of detrusor overactivity, voiding frequency per 24 h was significantly reduced from 9 to 6, and daily pad use rate was significantly improved (2.6 versus 0.6 pads per 24h). On comparing urodynamic assessment of detrusor function before and under SNM, no significant suppression of neurogenic detrusor overactivity (NDO) was detected. In nine patients with chronic neurogenic urinary retention, median postvoid residual urine was significantly reduced from 370 to 59 ml. In all, 94% of the patients were either very satisfied or satisfied with SNM. Conclusion: SNM might be an additional therapy option in carefully selected patients with NLUTD. On the basis of our results, urodynamic evaluation before SNM is mandatory, as the procedure does not seem to be suited to significantly alleviate NDO. INTRODUCTIONThe physiological function of the lower urinary tract (LUT) is storage and controlled evacuation of urine. The LUT is controlled by spinal, supraspinal and cerebral networks. 1-3 Because of the complexity of the neural interactions, damage of at least one of the components can cause LUT dysfunction (NLUTD). 4 Depending on the neurologic disease and the location of the lesion, various forms of NLUTD can occur. Depending on the type of dysfunction, NLUTD can affect the upper urinary tract with the risk of renal failure, and it can impair the quality of life. 5,6 Therefore, treatment of NLUTD is not based on symptoms alone, but it should focus on the results of urodynamic testing.Sacral neuromodulation (SNM) is a minimally invasive approach for the treatment of LUT dysfunction. The mechanism of action is not completely clarified, but a central modulation of afferent and efferent signals in the spinal cord and the supraspinal areas seems to have a crucial role. 2 Although the efficacy and safety of SNM in patients with idiopathic LUT dysfunction has been frequently demonstrated, its effectiveness in patients with NLUTD is not well documented. [7][8][9][10] In particular, there is a lack of clinical studies reporting urodynamic results after SNM.The aim of th...

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Clinical Outcomes of Sacral Neuromodulation in Patients With Neurologic Conditions

Cited by 77 publications

References 12 publications

Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease

Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease

The management of urinary incontinence in the male neurological patient

Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction

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