Sacral Neuromodulation: Cost Considerations and Clinical Benefits

Aboseif, Sherif R.; Kim, Dennis H.; Rieder, Jocelyn M.; Rhee, Eugene; Menefee, Shawn A.; Kaswick, Julie R.; Ree, Michael H.

doi:10.1016/j.urology.2007.07.073

Cited by 41 publications

(23 citation statements)

References 17 publications

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“…Literature reports that the cost-effective analysis of SNM has shown to be an efficient measure with an incremental costeffective ratio regarding bowel or lower urinary tract dysfunction, compared with earlier LUTS therapies such as catheters and anticholinergic drugs. 17 In fact, it was recently shown that the managing of SCI bladder and bowel dysfunction through a neuroprosthesis implant of the anterior sacral nerves with posterior rhizotomy greatly reduces the cost of pharmacological therapies. 18 Even the possibility for individuals with incomplete SCI lesions to have significant concomitant clinical positive benefits for LUTS, bowel function and sexuality with SNM could massively reduce the cost of therapy, compared with earlier chronic pharmacological treatments or time-consuming procedures such as intravesical electrostimulation or Stoller afferent neurostimulation, positively affecting the individual's psychological and social life as well.…”

Section: Discussionmentioning

confidence: 99%

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

Lombardi

Popolo

2009

Spinal Cord

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Objective: To determine the efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord injured (SCI) subjects affected by neurogenic lower urinary tract symptoms (NLUTS). Methods: Twenty-four SCI patients were enrolled. The individuals were divided into two groups: 13 individuals in the urinary retention category and 11 suffering from overactive bladder syndrome. All subjects underwent definitive SNM implantation (Medtronic, Inc.). Voiding symptoms were assessed using patient bladder diaries, which recorded both pre-SNM and before each follow-up (1, 3 and 6 months, and then every 6 months). Outcome measures were per 24 h: number of voids and voided volume per void for both groups; number of urinary leakages, pad use and nocturia for patients with overactive bladder syndrome; and volume per catheterization and number of catheterizations for urinary retention subjects only. Final checkups were completed by June 2008. Results: Median follow-up was 61 months. Up to the final visit, all subjects maintained a clinical improvement of more than 50% compared with baseline. Twenty-two side effects were recorded. Four subjects with urinary retention needed a new implant in the controlateral S3 sacral root because of loss of efficacy. One patient with urinary retention developed a wound infection at the implanted pulse generator site. Conclusions: Our study contains the largest series of implanted SCI patients ever published. SNM is a therapy to consider in the treatment of NLUTS for partial SCI patients, even if the loss of clinical benefits for patients with retentive NLUTS must be taken into account. All adverse events were treated effectively.

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Section: Discussionmentioning

confidence: 99%

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

Lombardi

Popolo

2009

Spinal Cord

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“…The latter is the most recommended, as it provides better results and fewer side effects (19,20). The use of sacral neuromodulators and minimally invasive intervention stand out among surgical interventions, as these practices were approved by the Food and Drug Administration (FDA), in 2002, to be employed in overactive bladder (21) treatment. Surgical options to treat SUI may include abdominal and vaginal procedures, laparoscope and related practices (22).…”

Section: Methodsmentioning

confidence: 99%

Physical therapy treatment in incontinent women provided by a Public Health Service

et al. 2011

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INTRODUCTION: Urinary incontinence affects more than 50 million people worldwide, it has a great impact on quality of life by affecting social, domestic, occupational and sex life, regardless of age. Objective: The objective of this study was to analyze the effectiveness of physical therapy treatment in women attending the Urogynecology service of Hospital and Maternity Leonor Mendes de Barros. METHOD: We retrospectively assessed 65 records of patients with diagnosis of urinary incontinence treated between November 2005 and November 2006. In order to have their data analyzed, patients were divided into two groups; group MF, which underwent medical treatment and physiotherapy, and group M, which had only medical treatment. In order to compare both groups' quantitative data, the analysis was performed in Statistica® software using Mann Whitney's non-parametric test. The analysis of association between the quantitative variables was performed through the Chi-Square test at 5% (p > 0.05) significance level. RESULTS: We observed that 60.6% of patients who underwent physical therapy treatment and medical treatment had the urinary incontinence symptoms decreased or completely cured, while 80% of women belonging to the medical treatmen only-group underwent surgery. CONCLUSION: Thus, we conclude that physical therapy is essential in treatment protocols of urinary incontinence outpatient clinics and to prevent surgery.

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“…Aboseif et al [46] evaluated the health care utilization for the year before and year after SNM implantation, including hospital and clinic visits, diagnostic and therapeutic procedures, and prescriptions. Outpatient visits for urinary symptoms decreased significantly after implantation, resulting in a 73% reduction in average yearly office visit expenditure, from $994 to $265 per patient.…”

Section: Cost Considerationsmentioning

confidence: 99%

Update on Neuromodulation

Gomelsky

Dmochowski

2011

Curr Bladder Dysfunct Rep

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Neuromodulation has become an integral part of our treatment algorithm for overactive bladder symptoms refractory to conservative therapy and for nonobstructive urinary retention. Long-term outcomes are available for sacral neuromodulation and reflect high satisfaction rates and acceptable rates of revision and reoperation. Recent studies suggest that there also may be beneficial outcomes in patients with symptoms related to the bowels or with pelvic pain. Likewise, pediatric patients may also derive benefit from this type of therapy. Although other forms of neuromodulation have only recently emerged, there is already evidence to suggest that stimulation of the dorsal tibial, pudendal, and dorsal genital nerves may provide benefits in the aforementioned conditions. Although longterm outcomes and placebo-controlled studies are generally lacking, there are few adverse events, and therapy may be performed with minimal anesthetic requirements. Further cost-effectiveness analyses also will be helpful if these procedures are to be adopted into routine use.

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Sacral Neuromodulation: Cost Considerations and Clinical Benefits

Cited by 41 publications

References 17 publications

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

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

Physical therapy treatment in incontinent women provided by a Public Health Service

Update on Neuromodulation

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