Sacral Neuromodulation in the Treatment of Urgency-Frequency Symptoms: A Multicenter Study on Efficacy and Safety

Hassouna, Magdy; Siegel, Steven; Ànÿeholt, A.A.B. Lycklama; Elhilali, Mostafa; Kerrebroeck, Philip E. V. A. Van; Das, Anupam; Gajewski, Jerzy; Janknegt, R. A.; Rivas, David A.; Dijkema, H.E.; Milam, Douglas F.; Oleson, Kimberly A.; Schmidt, Richard A.

doi:10.1016/s0022-5347(05)67558-1

Cited by 320 publications

(206 citation statements)

References 15 publications

Supporting

Mentioning

190

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, it is felt that neuromodulation treats bladder overactivity via its a¡ects on the activity and basal tone of the pelvic £oor [Schmidt et al, 1999]. A number of randomized, multi-center trials have demonstrated the e¡ectiveness and durability of sacral neuromodulation in the treatment of refractory voiding dysfunction [Schmidt et al, 1999;Hassouna et al, 2000;Siegel et al, 2000;Janknegt et al, 2001]. Furthermore, the role of sacral neuromodulation in treating other pelvic £oor disorders including interstitial cystitis, pelvic pain syndromes, and bowel dysfunction have shown encouraging results but require statistically powered multi-center trials with longer follow up [Pettit et al, 2002;Bernstein and Peters, 2005].…”

Section: Discussionmentioning

confidence: 99%

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Starkman

Wolter

Scarpero

et al. 2006

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Aims: We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods: A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: signi¢cant response (80% improvement), moderate response (50% and <80% improvement), and poor response (<50% response). Results: Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal ¢stula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no signi¢cant di¡erences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion: Sacral neuromodulation appears to be an e¡ec-tive therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality. Neurourol. Urodynam. 26: 29^35, 2007. ß 2006

show abstract

Section: Discussionmentioning

confidence: 99%

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Starkman

Wolter

Scarpero

et al. 2006

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

show abstract

“…Once stimulation was again restarted, these patients regained sustained efficacy at 12-and 24-month intervals. 6 Spinelli et al 39 reported on a total of 196 patients enrolled in the Italian Register who had been implanted for a variety of voiding dysfunction. For patients with incontinence associated with detrusor instability, the mean incontinent episodes declined from about five a day to one; in patients with idiopathic retention the residual volume declined from 277 to 108 mL, with 50% of patients no longer needing catheterization.…”

Section: Figmentioning

confidence: 99%

“…4 More recent multicenter studies provided data on neuromodulation that led to U.S. Food and Drug Administration (FDA) approval of sacral nerve root stimulation for clinical use for voiding dysfunction. 5,6 …”

Section: Introductionmentioning

confidence: 99%

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Mayer

Howard

2008

Neurotherapeutics

View full text Add to dashboard Cite

Summary:Voiding dysfunction, which includes incontinence, retention, and chronic pelvic pain, is a relatively frequent problem that can be difficult to manage. Neuromodulation via stimulation of the sacral nerves has been shown to improve thesesymptoms, although the exact mechanisms remain elusive. Techniques for nerve stimulation may vary, depending on the disease, location of pain, and the patient's anatomy. In addition to placement of electrodes on the sacral nerve roots, modulation has also been reported by peripheral branches of the sacral nerves including the pudendal and posterior tibial nerves. Newer surgical techniques have significantly decreased the morbidity of the procedures and increased the probability of a successful outcome.

show abstract

“…Hassouna et al 51 reported in 2000 on the treatment of UF symptoms with SNS therapy. In total 51 patients, a stimulation group of 25 patients and a control group of 26 patients, enrolled in this multicenter trial.…”

Section: Clinical Resultsmentioning

confidence: 99%

Sacral nerve stimulation for neuromodulation of the lower urinary tract

Oerlemans

Kerrebroeck

2007

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Patients with symptoms of overactive bladder syndrome or non-obstructive urinary retention, refractory to conservative therapy, can nowadays be treated minimally invasively with sacral nerve stimulation (SNS). The use of electric currents to treat urological pathology has a long history but SNS therapy only received FDA approval in 1997. The mechanisms of action are still not known so there are different theories explaining the modulation effect. Recent studies have shown a central modulation effect. Predictive factors which can help to identify the perfect candidates are not known. Over the years the technique of SNS has become less invasive and because of two stage implantation test results have proven to be more reliable. The clinical results for this therapy have proven to be safe and effective and with the technical improvements over the years the re-operation and complication rates have decreased significantly. The clinical results have led to expanding indications because of positive effects in other symptoms. In the field of urology this has resulted in the use of SNS therapy for interstitial cystitis, neurogenic lower urinary dysfunction, and pediatric voiding dysfunction. In the field of gastro-intestinal pathology, SNS therapy is used to treat faecal incontinence and constipation.

show abstract

Sacral Neuromodulation in the Treatment of Urgency-Frequency Symptoms: A Multicenter Study on Efficacy and Safety

Abstract: Neuromodulation of the sacral nerves is an effective, safe therapy that successfully treats significant symptoms of refractory urgency-frequency.

Cited by 320 publications

References 15 publications

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Sacral nerve stimulation for neuromodulation of the lower urinary tract

Contact Info

Product

Resources

About