Sacral Nerve Neuromodulation in the Treatment of Patients With Refractory Motor Urge Incontinence: Long-Term Results of a Prospective Longitudinal Study

Bosch, J.L.H. Ruud; Groen, Jan

doi:10.1016/s0022-5347(05)67728-2

Cited by 168 publications

(82 citation statements)

References 15 publications

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“…14 In studies that were submitted for FDA approval of the Interstim ® product, 47% of the overall subjects enrolled (including screened and implanted subjects) reported a >50% reduction in IE per day, 57% reported a >50% reduction in heavy leaks, and 52% reported >50% reduction in PPD. 15 Further, the present results obtained with percutaneous stimulation, are comparable to results of other innovative approaches using implanted hardware.…”

Section: Discussionmentioning

confidence: 99%

Dorsal genital nerve stimulation for the treatment of overactive bladder symptoms

Goldman

Amundsen

Mangel

et al. 2007

Neurourology and Urodynamics

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Aim-To evaluate percutaneous placement of electrodes adjacent to the dorsal genital nerve (DGN) and measure the effects of electrical stimulation on symptoms of urge incontinence during 1 week of home use.Methods-Prospective, multicenter study. Subjects with urge incontinence underwent percutaneous placement of an electrode using local anesthetic. Test stimulation was applied to confirm electrode placement and cystometry was conducted with and without application of electrical stimulation. A 7-day testing period with the electrode connected to an external pulse generator was performed and was followed by a 3-day post-treatment test period. Bladder diaries, 24 hr pad tests, and adverse event queries were obtained.Results-Twenty-one women were enrolled with an average age of 52.7 years and average duration of incontinence of 6 years. Percutaneous electrode placement required 5-10 min and was well tolerated. There was no relationship between the acute effects of stimulation on cystometry and the results during home use. Pad weight was reduced by ≥50% in 13 of 17 subjects (76%) (4 did not complete 24 hr pad testing) and 47% of subjects reported ≥50% reduction in incontinence episodes. Of the subjects who reported severe urgency at baseline, 81% experienced a 50% or greater improvement. Seven subjects experienced nine adverse events ranging from skin irritation to pain and bruising around the electrode exit site. Conclusions-Electrodes to stimulate the DGN can be placed percutaneously and a home testing period showed a reduction in overactive bladder symptoms with DGN stimulation.

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Section: Discussionmentioning

confidence: 99%

Dorsal genital nerve stimulation for the treatment of overactive bladder symptoms

Goldman

Amundsen

Mangel

et al. 2007

Neurourology and Urodynamics

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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 > 50% reduction in pad use and/or leaks) 47% did not have DO while overactivity was still present in the remaining successful patients. There was a > 90% reduction in pads and/or leaks in 72% of those without DO but in only 45% of those with persisting DO [67]. Groenendijk et al [68] while comparing the outcome of patients with UUI with or without pre-implant DO, also reported that DO resolved in about half of the patients.…”

Section: Urodynamicsmentioning

confidence: 96%

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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Sacral Nerve Neuromodulation in the Treatment of Patients With Refractory Motor Urge Incontinence: Long-Term Results of a Prospective Longitudinal Study

Abstract: Sacral nerve neuromodulation is safe, effective and durable in patients with urge incontinence refractory to conservative treatment.

Cited by 168 publications

References 15 publications

Dorsal genital nerve stimulation for the treatment of overactive bladder symptoms

Dorsal genital nerve stimulation for the treatment of overactive bladder symptoms

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

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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