The first Iraqi experience in sacral neuromodulation for patients with lower urinary tract dysfunction

Abstract

ObjectivesTo present our experience, in Iraq, with sacral neuromodulation (SNM) in patients with refractory lower urinary tract dysfunction, with discussion of the factors that affect the response rate.Patients and methodsIn this prospective, clinical, interventional study, 24 patients were evaluated and treated by a team comprised of a Urologist and a Neurosurgeon with SNM over a 1.5-year period. The gender, age, pathology, and clinical presentation, were all studied and evaluated. Successful clinical response was defined as achieving a ≥50% improvement in voiding diary variables.ResultsThe mean age of those that responded to SNM was 28 years, with females responding better than males (10 of 14 vs four of 10). The SNM response rate according to presentation was six of 10 in those with overactive bladder/urge urinary incontinence, six of nine of those with urinary retention, and two of five in those with a mixed presentation. The response rate in idiopathic voiding dysfunctions was 11 of 13, whilst for neurogenic dysfunctions it was three of 11. Other benefits such as in bowel motion, erectile function, menstruation, power of lower limbs, and quality of life (QoL), were also recorded. The complications were reasonable for this minimally invasive procedure.ConclusionSNM offers a good and durable solution for some functional bladder problems, if patients are well selected. There may also be additional extra-urinary benefits that contribute to improvements in QoL. SNM was well tolerated by our patients with an encouraging response rate, especially in psychologically stable patients with idiopathic dysfunctions.

A comparative study between sacral neuromodulation and intravesical botulinum toxin injection for patients with refractory overactive bladder

“…The percentage of those patients who continued to have a positive response at 6 months after intervention was good and comparable in both arms of the study, as has been found in other studies of BTX and SNM [ 10 , 15 , 16 ]. It was even higher than the percentage of durable response achieved in our earlier study on SNM [ 7 ], which is due to the fact that in the earlier study, patients with neurogenic OAB were also included, while in the present study only patients with idiopathic OAB were included.…”

“…Three patients in the SNM group had a diminution in response during the follow-up months, which was either due to IPG dysfunction or explained by the theory that possibly different brain areas were affected during different periods of neuromodulation (early and late), which may account for the change in response in some patients with time [ 7 ]. Weil et al [ 14 ] also reported an important association between late loss of therapeutic response and the existence of former psychiatric problems.…”

“…Treatment success is usually judged by improvement in voiding diaries, subjective patient satisfaction, and QoL scores [ 7 ].…”

“…After 2010, some Iraqi urologists started to use intradetrusor BTX injections and in 2015 Al-Azzawi and Al-Tamimi [ 7 ], introduced sacral neuromodulation (SNM) for the first time in Iraq, for the treatment of various lower urinary tract dysfunctions, including patients with refractory OAB.…”

Systematic Literature Review and Meta-Analysis of Sacral Neuromodulation (SNM) in Patients with Neurogenic Lower Urinary Tract Dysfunction (nLUTD): Over 20 Years’ Experience and Future Directions

“…Twenty-one studies comprising a total of 887 patients were included in the meta-analysis of test SNM and the pooled test SNM success rate was 66.2% (95% CI 56.9–74.4) (Fig. 4 a) [ 21 , 29 , 32 – 50 ]. Twenty-four studies with a total of 428 patients were included in the meta-analysis of permanent SNM [ 21 , 26 , 29 , 31 – 38 , 40 , 42 – 45 , 48 , 49 , 51 – 56 ].…”