Efficacy of Sacral Nerve Stimulation for Urinary Retention: Results 18 Months After Implantation

Jonas, Udo; Fowler, Clare J.; Chancellor, Michael B.; Elhilali, Mostafa; Fall, Magnus; Gajewski, Jerzy; Grünewald, V.; Hassouna, Magdy; Hombergh, Ubi van den; Janknegt, R. A.; Kerrebroeck, Ph.E.V. Van; Nijeholt, A.A.B. Lylcklama à; Siegel, Steven; Schmidt, Richard A.

doi:10.1097/00005392-200101000-00004

Cited by 309 publications

(171 citation statements)

References 23 publications

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“…Urinary retention is the inability to empty the bladder completely, and can lead to significant complications. Non-obstructive retention occurs when bladder pressure is insufficient to overcome outlet resistance and may result from bladder muscle hypocontractility (Jonas et al 2001), increases in the outlet resistance (Goodwin et al 1998), or both. Chronic urinary retention can lead to several urological complications including reflux, upper urinary tract damage, urinary tract infection, and overflow incontinence.…”

Section: Introductionmentioning

confidence: 99%

Improved bladder emptying in urinary retention by electrical stimulation of pudendal afferents

et al. 2008

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Urinary retention is the inability to empty the bladder completely, and may result from bladder hypocontractility, increases in outlet resistance, or both. Chronic urinary retention can lead to several urological complications and is often refractory to pharmacologic, behavioral, and surgical treatments. We sought to determine whether electrical stimulation of sensory fibers in the pudendal nerve could engage an augmenting reflex and thereby improve bladder emptying in an animal model of urinary retention. We measured the efficiency of bladder emptying with and without concomitant electrical stimulation of pudendal nerve afferents in urethane anesthetized rats. Voiding efficiency (VE=voided volume/initial volume) was reduced from 72±7% to 29±7% following unilateral transection of the sensory branch of the pudendal nerve (UST) and from 70±5% to 18±4% following bilateral transection (BST). Unilateral electrical stimulation of the proximal transected sensory pudendal nerve during distention-evoked voiding contractions significantly improved VE. Low intensity stimulation at frequencies of 1-50 Hz increased VE to 40-51% following UST and to 39-49% following BST, while high intensity stimulation was ineffective at increasing VE. The increase in VE was mediated by increases in the duration of distention-evoked voiding bladder contractions, rather than increases in contraction amplitude. These results are consistent with an essential role for pudendal sensory feedback in efficient bladder emptying, and raise the possibility that electrical activation of pudendal nerve afferents may provide a new approach to restore efficient bladder emptying in persons with urinary retention.

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Section: Introductionmentioning

confidence: 99%

Improved bladder emptying in urinary retention by electrical stimulation of pudendal afferents

et al. 2008

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“…Although the mechanism of action is not fully understood, voiding dysfunction at both extremes of U/F and UR seem to respond well, with long-term success and safety noted by numerous studies [Bosch and Groen, 2000;Chartier-Kastler et al, 2000;Hassouna et al, 2000;Siegel et al, 2000;Janknegt et al, 2001;Jonas et al, 2001;Dasgupta et al, 2004;Brazzelli et al, 2006]. Other pathological conditions within the pelvis have also appreciated bene¢t from SNS therapy, to include chronic pelvic pain, constipation/obstipation, irritable bowel syndrome, and fecal incontinence Kene¢ck and Christiansen, 2004;Peters and Konstandt, 2004;Bernstein and Peters, 2005;Jarrett, 2005].…”

Section: Introductionmentioning

confidence: 99%

Sacral nerve stimulation for voiding dysfunction: One institution's 11‐year experience

Sutherland

Lavers

Carlson³

et al. 2006

Neurourology and Urodynamics

125

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Aim: The purpose of this study was to review our institution's 11-year experience with SNS for the treatment of refractory voiding dysfunction. Dating back to 1993, it covers a span of time which describes the evolution of SNS as it includes PNE trials, non-tined (bone-anchored or fascial-anchored) leads, percutaneous tined leads with two-staged procedures, and even percutaneous pudendal trials. Methods: A retrospective review was performed on SNS patients who received an implantable pulse generator (IPG) in our practice from 12/1993 to 12/2004. After Institutional Review Board approval, consents for chart review were obtained from 104 patients, representing 44% of this neuromodulatory patient population. Results: Of our population, 87% were female and 13% were male. Average age at implant was 50 years AE 13.4 years. Duration of symptoms before implantation was 116 months (range 9^600 months). Eighty percent were implanted for a predominant complaint of urinary urgency and frequency (U/F). Overall, 22% had U/F only, 38% had concomitant urge incontinence (UI), and 20% had concomitant mixed incontinence (MI). Twenty percent were treated for non-obstructive urinary retention (UR), with half of these associated with a neurogenic etiology. Additionally, 46.2% had pelvic pain, 58.6% had bowel complaints, and 51% reported sexual dysfunction. In patients with U/F, mean voiding parameters as described by pre-implant voiding diaries revealed the following: 12.4 (AE5.1) voids per 24 hr; 2.3 (AE1.8) voids per night; 5.0 (AE4.7) leaks per 24 hr; and 2.3 (AE2.6) pads per 24 hr. Statistically signi¢cant improvements post-implantation were noted with mean decreases in the following: 4.3 voids per 24 hr; 1.0 void per night; 4.4 leaks per 24 hr; and 2.3 pads per 24 hr (all P < 0.05). In the UR group a statistically signi¢cant improvement post-implantation was noted only in voids per night, with a mean decrease of 0.8 (P < 0.05). With a mean follow up of 22 months (range 3^162 months), sustained subjective improvement was >50%, >80%, and >90% in 69%, 50%, and 35% of patients, respectively. By quality of life survey, 60.5% of patients were satis¢ed and 16.1% were dissatis¢ed with current urinary symptoms. Only 13% (14 patients) abandoned therapy, making up a signi¢cant portion of those dissatis¢ed with current urinary symptoms. Good overall lead durability was seen (mean 22 months, range 1^121 months), with the ¢rst successful lead proving to be the most durable (mean 28 months, range 1.41 20 months). Lead durability decreased progressively with subsequent trials. Overall, 53% of patients experienced at least one reportable event (RE) attributable to either lead or IPG. A total of 126 REs were noted, with 97% mild-to-moderate in severity. REs included lack of e⁄cacy, loss of e⁄cacy, infection, hematoma/seroma, migration, pain, undesirable change in sensation, and device malfunction. In this population, 47.1% of leads were tined while 52.9% were non-tined. Tined leads had an overall lower RE rate as compared to non-tined leads: 28% ...

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“…A report of the use of SNS in UR was published in 2001 by Jonas et al 52 177 patients with UR refractory to conservative therapy were enrolled in this multicenter trial between 1993 and 1998. Thirty-seven patients were assigned to treatment and 31 to the control group.…”

Section: Clinical Resultsmentioning

confidence: 99%

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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Efficacy of Sacral Nerve Stimulation for Urinary Retention: Results 18 Months After Implantation

Abstract: Results of this prospective, randomized clinical study demonstrate that sacral nerve stimulation is effective for restoring voiding in patients with retention who are refractory to other forms of treatment.

Cited by 309 publications

References 23 publications

Improved bladder emptying in urinary retention by electrical stimulation of pudendal afferents

Improved bladder emptying in urinary retention by electrical stimulation of pudendal afferents

Sacral nerve stimulation for voiding dysfunction: One institution's 11‐year experience

Sacral nerve stimulation for neuromodulation of the lower urinary tract

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