Results of Sacral Neuromodulation Therapy for Urinary Voiding Dysfunction: Outcomes of a Prospective, Worldwide Clinical Study

Kerrebroeck, Philip E. V. A. Van; Voskuilen, A.C. van; Heesakkers, John; Nijholt, August A.B. Lycklama á; Siegel, Steven; Jonas, Udo; Fowler, Clare J.; Fall, Magnus; Gajewski, Jerzy; Hassouna, Magdy; Cappellano, F.; Elhilali, Mostafa; Milam, Douglas F.; Das, Anupam; Dijkema, H.E.; Hombergh, Ubi van den

doi:10.1016/j.juro.2007.07.032

Cited by 485 publications

(384 citation statements)

References 17 publications

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“…This percentage is similar to other studies including other categories of patients suffering from non-obstructive chronic urinary retention. [12][13][14][15] However, the reasons for failure were identified in only two cases, and at this time we are only able to speculate on the unknown causes. Our findings showed that the time-duration of permanent SNM increased the possibility of failure, and the group of constant responders had a much shorter mean follow-up postpermanent SNM compared with the inconstant responder.…”

Section: Discussionmentioning

confidence: 80%

Sacral neuromodulation for neurogenic non-obstructive urinary retention in incomplete spinal cord patients: a ten-year follow-up single-centre experience

Lombardi¹,

Musco²,

Celso³

et al. 2014

Spinal Cord

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Objective: To determine the success rate of percutaneous first stage of sacral neuromodulation (SNM) and the efficacy and safety of permanent SNM for incomplete spinal cord lesion (SCL) patients suffering from chronic neurogenic non-obstructive urinary retention (N-NOR). Method: From January 2003 to December 2012, 85 individuals underwent the percutaneous first stage of SNM. Subsequently, only responders who reached a concomitant reduction by at least 50% of volume per catheterization and in the number of catheterizations per day comparing their 7-day voiding diaries at baseline underwent permanent SNM. Final follow-up was conducted by April 2013. Results: Thirty-six individuals responded to percutaneous first stage of SNM. Post-surgery urodynamics documented all patients experiencing first sensation of bladder filling. A statistically significant increase in Qmax ml per sec and decrease in post-voiding residual urine per ml were documented. (Po0.01). First sensation of bladder filling at baseline represented a statistically significant parameter for the success of the first stage SNM (Po0.05). Eleven out of 34 patients at follow-ups were 'inconstant responders' because they returned to similar baseline voiding symptoms, but responded again with an implant on the controlateral S3 sacral root. Two failed twice and responded once again after an S4 sacral root implant. All but one failure occurred more than 3 years after the previous implant. Other drawbacks were resolved telemetrically. Keywords: neurogenic non-obstructive urinary retention; sacral neuromodulation; aseptic intermittent catheterizations; urodynamics INTRODUCTION Neurogenic non-obstructive urinary retention (N-NOR) due to spinal cord lesion (SCL) may be treated with pelvic floor reeducation, or drugs such as alpha-blockers and parasympathomimetics, though these therapies are commonly unsuccessful. 1,2 Moreover, literature reports that with intravesical electrostimulation patients regained detrusor activity and increased awareness of bladder filling. 3,4 However, other authors show negative findings. 5,6 A recent review on the use of sacral neuromodulation (SNM) for neurogenic lower urinary tract dysfunction reports that no definitive conclusions can be drawn from the available evidence regarding this procedure for neurogenic lower urinary tract dysfunction. 7 The aim of this retrospective study is to address the success rate percentage of first stage SNM in individuals with an incomplete SCL. Moreover, medium-and long-term efficacy associated with the safety of permanent SNM on SCL subjects suffering from N-NOR were evaluated.

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Section: Discussionmentioning

confidence: 80%

Sacral neuromodulation for neurogenic non-obstructive urinary retention in incomplete spinal cord patients: a ten-year follow-up single-centre experience

Lombardi¹,

Musco²,

Celso³

et al. 2014

Spinal Cord

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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).…”

Section: Discussionmentioning

confidence: 99%

“…SNM has become a well-established treatment modality in recent years for patients with refractory non-obstructive chronic urinary retention, urgency-frequency syndrome and urgency incontinence. [4][5][6] Many patients have achieved significant improvement in lower urinary tract symptoms and bowel disorders, such as fecal incontinence and constipation. 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.…”

Section: Introductionmentioning

confidence: 99%

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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“…The study groups comprised of 96 patients of both men and women and 60 female patients [36,37]. Significantly less incontinence episodes were found in 58 and 50% of the patients, respectively, and in 61 and 53% significant less use of pads.…”

Section: Oab With or Without Urinary Incontinencementioning

confidence: 99%

Sacral Neuromodulation for the Treatment of Urinary Bladder Dysfunction: Mechanism of Action and Future Directions

Blok

2017

Bioelectron. Med.

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Symptoms of overactive bladder affect a large portion of the world population, especially the elderly. Sacral neuromodulation (SNM) is an effective third-line therapy in patients with overactive bladder. The working mechanism of SNM can be explained by the neural connections of the lower urinary tract. It is proposed that SNM does not work directly on the central components of the micturition reflex, but on cortical and subcortical areas, which in turn inhibits the micturition reflex components in the caudal brainstem. The clinical use and outcomes of SNM are described for several forms of bladder dysfunction. Furthermore, some recent new developments in SNM are discussed, such as expanded indications, more effective use of existing nonrechargeable neuromodulators and the introduction of a rechargeable device. Conservative treatment of overactive bladder (OAB) with or without urinary incontinence consists of pelvic floor exercises, medication and lifestyle intervention, including fluid restriction and timely voiding. If these conservative interventions fail, it is possible to offer electrical stimulation therapies, such as sacral neuromodulation (SNM). In patients suffering from urinary urgency, frequency and urgency incontinence, electrical stimulation of the sacral nerve significantly reduces urinary symptoms and improves patient quality of life. SNM is also used effectively for other forms of bladder dysfunction, such as underactive bladder and bladder pain syndrome (BPS). The increased use of minimally invasive SNM has decreased the need for more open surgical procedures such as ileocystoplasty and urinary diversion. SNM uses an implanted electrode to the third or fourth sacral spinal nerve to deliver a nonpainful electrical stimulus. The brain of the patient perceives this stimulus and, in turn, effectively restores bladder function and alleviates the patients' symptoms. Due to the system-oriented, and not organ-oriented, approach, SNM not only treats urinary disorders, but may also have a beneficial effect on bowel and sexual dysfunction as well as on pelvic pain. Normal control of the lower urinary tractIn order to understand the role of the brain in the control of the urinary bladder and its sphincter, one can make a distinction between structures and axonal tracts in the caudal brainstem and spinal cord, which are intrinsic part of the micturition and continence reflex, and structures and pathways, located in the forebrain and mesencephalon, which modulate these micturition and continence areas. Most of the clinical therapies aimed at functional bladder disorders are not specifically targeted to the micturition reflex areas, but influence cortical and subcortical brain areas, which, in turn, modulate the micturition reflex components. Examples of such therapies are pelvic floor physiotherapy, biofeedback, transcutaneous electrical nerve stimulation, posterior tibial nerve stimulation and SNM. Currently, there is no effective behavioral, chemical or electrical treatment which works directly and specifica...

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Results of Sacral Neuromodulation Therapy for Urinary Voiding Dysfunction: Outcomes of a Prospective, Worldwide Clinical Study

Abstract: This long-term study demonstrates that InterStim therapy is safe and effective for restoring voiding in appropriately selected cases refractory to other forms of treatment.

Cited by 485 publications

References 17 publications

Sacral neuromodulation for neurogenic non-obstructive urinary retention in incomplete spinal cord patients: a ten-year follow-up single-centre experience

Sacral neuromodulation for neurogenic non-obstructive urinary retention in incomplete spinal cord patients: a ten-year follow-up single-centre experience

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

Sacral Neuromodulation for the Treatment of Urinary Bladder Dysfunction: Mechanism of Action and Future Directions

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