Predictors of Success with Neuromodulation in Lower Urinary Tract Dysfunction: Results of Trial Stimulation in 100 Patients

Koldewijn, Evert L.; Rosier, Peter; Meuleman, E.J.H.; Köster, Anja; Debruyne, F.M.J.; Kerrebroeck, Philip E. V. A. Van

doi:10.1016/s0022-5347(17)32311-x

Cited by 157 publications

(75 citation statements)

References 17 publications

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“…Similar to the ¢ndings of Koldewijn et al [1994] we did not ¢nd age or gender to be predictors of success for SNS. This is contrary to the ¢ndings of Amundsen et al [2005] where both younger (<55 years) and healthier (fewer co-morbidities) patients experienced signi¢cantly greater clinical success with SNS.…”

Section: Discussionsupporting

confidence: 80%

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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Section: Discussionsupporting

confidence: 80%

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

Sutherland

Lavers

Carlson³

et al. 2006

Neurourology and Urodynamics

125

View full text Add to dashboard Cite

show abstract

“…To date there are no predictive factors, e.g. urodynamics, age, history or gender [10]. Some patients have a successful acute PNE test and sometimes for 1-2 days, but it is insufficient for a permanent implant using our present criteria.…”

Section: Discussionmentioning

confidence: 83%

Long‐term efficacy and safety results of the two‐stage implantation technique in sacral neuromodulation

et al. 2002

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Objective To assess the long-term efficacy and safety of two-stage sacral neuromodulation with an implantable pulse generator (IPG) in patients treated for urinary urge incontinence (UI) and/or urinary retention (UR). Patients and methods The two-stage technique is used ifpatients have a good response during the acute phase of the percutaneous nerve evaluation (PNE) test, but have a poor response during the following 4-7 days (subchronic phase). In the first stage only the permanent electrode was implanted and connected to a temporary external stimulator, allowing patients to be assessed for longer. If the main symptoms improved by more than half the patient proceeded to the second stage, the insertion of the IPG. We reviewed all patients who underwent two-stage implantation; all had signed an informed consent and were asked to complete voiding diaries and a questionnaire to assess the subjective effects of the therapy. Safety was assessed from relevant medical events, management, and relative to the therapy and resolution. Residual urine was assessed by selfcatheterization. The long-term voiding diary results were compared with baseline estimates and analysed statistically using the two-sided Student's t -test. Results Between 1991 and 1998, 15 patients (13 women and two men, mean age 53 years, range 44-66) underwent the two-stage technique; the mean (median, range) follow-up was 4.9 (5.2, 2.5-7.5) years. Seven patients had UI and seven had UR, with one having both. The mean (range) number of PNEs undertaken in each patient was 2.1 (1-4) and these all failed in the subchronic phase. All patients underwent a first-and second-stage implant after a mean (range) screening period of 12.2 (2-29) days. One patient was explanted after implantation of only the first stage, and two others explanted in a later phase because the IPG was ineffective during the follow-up. The voiding diary results of the remaining 12 patients showed improvement in all the main variables, and in the subjective assessment 11 reported an improvement and were satisfied with the therapy. There were 17 adverse events, 14 of which were resolved and seven of which required surgical intervention. Conclusion The long-term results of the two-stage implantation show clinically and statistically significant improvements, probably because the implantation of the lead (first stage) more closely resembles the final therapy. If a temporary PNE test is not optimal (lead migration, longer testing needed), the two-stage technique can offer a good and safe alternative of comparable efficacy in the long-term. If the two-stage technique had not been available to these 12 patients they would not have been offered neuromodulation.

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“…Attempts to identify factors predicting the success of SNM have largely failed [29]. Later, Scheepens et al .…”

Section: Test Stimulationmentioning

confidence: 99%

An update on sacral neuromodulation: where do we stand with this in the management of lower urinary tract dysfunction in 2010?

Bosch

2010

BJU International

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Predictors of Success with Neuromodulation in Lower Urinary Tract Dysfunction: Results of Trial Stimulation in 100 Patients

Cited by 157 publications

References 17 publications

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

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

Long‐term efficacy and safety results of the two‐stage implantation technique in sacral neuromodulation

An update on sacral neuromodulation: where do we stand with this in the management of lower urinary tract dysfunction in 2010?

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