Sacral neuromodulation for detrusor hyperactivity with impaired contractility

Hennessey, Derek; Hoag, Nathan; Gani, Johan

doi:10.1002/nau.23255

Cited by 21 publications

(12 citation statements)

References 33 publications

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“…Sacral neuromodulation has the potential to control both UUI and compromised detrusor contractile function. Hennessey and Hoag reported that sacral neuromodulation for patients with DHIC could ameliorate OAB symptoms and decrease in PVR although they did not show an improvement in UUI due to the small patient numbers [ 43 ].…”

Section: Managementmentioning

confidence: 99%

Management of Urinary Incontinence With Underactive Bladder: A Review

Cho

Kim

2020

Int Neurourol J

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Urinary incontinence is caused by storage function failure, while underactive bladder (UAB) is caused by a decline in detrusor contractility and voiding dysfunction. As the treatment mechanisms for incontinence and UAB are contrary to each other, it is difficult to treat both incontinence and UAB, and the patient’s quality of life can be further degraded. Conventional midurethral sling (MUS), such as transobturator tape or retropubic MUS, introduces a risk of postoperative voiding dysfunction in stress urinary incontinence with UAB. However, there have been several reports about the efficacy and safety of conventional MUS. Adjustable sling procedures, such as transobturator adjustable tape or the Remeex system, have better outcomes than conventional MUS because they control tension both during and after surgery. When voiding dysfunction occurs after incontinence treatment with UAB, voiding symptoms can be improved by various therapeutic modalities. Clean intermittent catheterization is recommended for patients with significant increased postvoid residual volumes or urinary retention. Although pharmacotherapy such as with alpha-blockers or parasympathomimetics can be considered for UAB, there is insufficient evidence of their effect on incontinence with UAB. Future therapies, such as stem cell therapy or gene therapy, may be used to treat incontinence with UAB. The possibility of management urgency urinary incontinence that related to detrusor hyperactivity with impaired contractility using sacral neuromodulation has been suggested. Further research is needed to establish evidence for the efficacy and safety of treatments for incontinence with UAB and improve patient quality of life.

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Section: Managementmentioning

confidence: 99%

Management of Urinary Incontinence With Underactive Bladder: A Review

Cho

Kim

2020

Int Neurourol J

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“…One could hypothesize that identifying DU could impact treatment decision-making as well. Indeed, recent series suggested that the safety and efficacy of sacral neuromodulation was preserved in patients with DU and coexisting DO while intradetrusor botulinum toxin injections was less effective in this subgroup [26,27]. Hypothetically, urodynamic findings might influence the selection of several other treatment options (beta 3 agonist vs. anticholinergics in obstructed vs. unobstructed, etc.).…”

Section: Discussionmentioning

confidence: 99%

Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease

et al. 2019

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PurposeTo assess the urodynamic findings in patients with Parkinson disease (PD) with overactive bladder symptoms.MethodsWe performed a retrospective chart review of all PD patients who were seen in an outpatient clinic for lower urinary tract symptoms (LUTS) between 2010 and 2017 in a single-institution. Only patients who complained of overactive bladder (OAB) symptoms and underwent a video-urodynamic study for these symptoms were included. We excluded patients with neurological disorders other than PD and patients with voiding LUTS but without OAB symptoms.ResultsWe included 42 patients (29 men, 13 women, 74.5±8.1 years old). Seven patients (16.7%) had a postvoid residual (PVR) bladder volume >100 mL and only one reported incomplete bladder emptying. Detrusor overactivity (DO) was found in all 42 patients (100%) and was terminal in 19 (45.2%) and phasic in 22 patients (52.4%). Eighteen patients had detrusor underactivity (DU) (42.3%). Later age of PD diagnosis was the only parameter associated with DU (P=0.02). Patients with bladder outlet obstruction (BOO) were younger than patients without BOO (70.1 years vs. 76.5 years, P=0.004), had later first sensation of bladder filling (173.5 mL vs. 120.3 mL, P=0.02) and first involuntary detrusor contraction (226.4 mL vs. 130.4 mL, P=0.009).ConclusionsDO is almost universal in all patients with PD complaining of OAB symptoms (97.1%). However, a significant percentage of patients also had BOO (36.8%), DU (47%), and increased PVR (16.7%) indicating that neurogenic DO may not be the only cause of OAB symptoms in PD patients.

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“…Bladder contractility significantly improved following SNM in a cohort with detrusor underactivity who had “detrusor hypocontractility” on urodynamics . In a cohort of patients with detrusor overactivity with impaired contractility (DHIC), a typical condition in the elderly, 70% undergoing test stimulation showed a treatment response and both DO during filling and DU during voiding improved …”

Section: Assessmentmentioning

confidence: 99%