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

Abstract

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% ...

Clinical outcome of sacral neuromodulation in incomplete spinal cord injured patients suffering from neurogenic lower urinary tract symptoms

“…Hence, an SNM evaluation should be considered for incomplete SCI patients with overactive bladder syndrome in case of anticholinergic failure, as well as for SCI subjects with non-obstructive urinary retention. 11,12 However, in our sample, the percentage occurrence of late failures in urinary retention subjects because of loss of efficacy (30.7%) is to be taken into account, even though all patients developing device failure responded to controlateral Sacral neuromodulation in SCI patients G Lombardi and G del Popolo sacral S3 lead placement. In addition, SNM is safe; in fact, the percentage of adverse events was low overall, and all were treated effectively with only five cases necessitating surgical intervention.…”

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

“…Most published studies, including those for FDA approval, are of relatively short duration (Ͻ1-2 years). Latini et al 44 reported that 90% of patients maintained a 50% reduction of urge incontinence symptoms (median follow-up, ϳ1 year), and Siegel's group 45 reported that ϳ70% of their patients indicated an improvement of Ͼ50% (mean follow-up, 22 months). In women with retention due to Fowler's syndrome, nearly 80% of patients implanted were reported to have persistent benefit, 46 although 54% had required revision procedures.…”

Neuromodulation in Management of Overactive Bladder

“…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 QOL survey, 60.5% of patients were satisfied with current urinary symptoms (Sutherland et al, 2007).…”