Unilateral versus bilateral stage I neuromodulator lead placement for the treatment of refractory voiding dysfunction

Pham, Khanh; Guralnick, Michael L.; O'Connor, R Corey

doi:10.1002/nau.20577

Cited by 33 publications

(25 citation statements)

References 8 publications

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“…[10][11][12] Our success rates in this study fall within the published norms. Several authors have demonstrated that advanced patient age, male gender, increased duration of symptoms and the presence of concomitant medical comorbidities decrease the likelihood of success following SNM.…”

Section: Discussionsupporting

confidence: 85%

Sacral neuromodulation outcomes for the treatment of refractory idiopathic detrusor overactivity stratified by indication – lack of anticholinergic efficacy versus intolerability

Davis

Makovey

Guralnick

et al. 2013

CUAJ

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Introduction: Patients may fail oral overactive bladder therapies due to either poor drug efficacy or intolerability. We determined if the success of sacral neuromodulation varies if performed secondary to lack of anticholinergic efficacy versus drug intolerability. Methods: A retrospective review was performed on 152 patients undergoing staged sacral neuromodulation from 2004 to 2010 for refractory idiopathic detrusor overactivity with or without urge incontinence. Outcomes following sacral neuromodulation trials were compared based on the primary indication for anticholinergic failure: lack of drug efficacy versus intolerable side effects. Results: Overall, successful sacral neuromodulation trials were reported in 70% (106/152) of patients. Successful outcomes were noted in 70% (89/128) and 71% (17/24) of patients with poor anticholinergic efficacy and drug intolerability, respectively (p = NS). Conclusions: We found no significant difference in outcome success in patients undergoing sacral neuromodulation trials for refractory detrusor overactivity due to lack of anticholinergic efficacy versus intolerability.

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Section: Discussionsupporting

confidence: 85%

Sacral neuromodulation outcomes for the treatment of refractory idiopathic detrusor overactivity stratified by indication – lack of anticholinergic efficacy versus intolerability

Davis

Makovey

Guralnick

et al. 2013

CUAJ

Self Cite

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“…Pham et al placed unilateral stage 1 S3 leads in 55 patients and bilateral leads in 69 patients with refractory voiding dysfunction. Stage I trials were successful in 32/55 (58%) and 53/69 (76%) of unilateral and bilateral cohorts, respectively ( P =0.03), with no statistically significant difference in complications 16. Scheepens et al evaluated unilateral versus bilateral stimulation in patients with chronic voiding dysfunction.…”

Section: Pathophysiology/mechanismmentioning

confidence: 99%

Sacral neuromodulation in overactive bladder: a review and current perspectives

Sukhu¹,

Kennelly²,

Kurpad³

2016

RRU

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Overactive bladder (OAB) symptoms of urgency, frequency, and urge incontinence currently affect a substantial portion of the population, especially as age increases. Sacral neuromodulation has become a popular option for refractory OAB symptoms over the past 2 decades. Studies have demonstrated that it is an effective treatment for OAB and urge incontinence as indicated by decreased number of voids, increased bladder capacity, and fewer leakage events. In addition, the effects have proved to be durable to multiple years following implantation. These benefits come at the expense of a high rate of adverse events, although with comparable long-term cost-effectiveness to botulinum toxin A. We aimed to review the literature that demonstrates that sacral neuromodulation continues to be an efficacious treatment for refractory OAB wet and dry patients, with continuously expanding indications.

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“…Testing can be done with one electrode or with two bilaterally placed electrodes 35. The Pham study reported significantly higher success rates of the PNE test in patients who were evaluated with bilateral electrodes, but these results were not supported by an earlier study by Scheepens et al36,37 After the procedure, the patients are evaluated to objectify how much improvement is in their symptoms with SNS. This is done with voiding diaries and urodynamic investigations (especially in patients with urinary retention).…”

Section: Neuromodulationmentioning

confidence: 98%

Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives

Janssen¹,

Martens²,

Wall³

et al. 2017

MDER

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ObjectivesThis review describes the evidence from established and experimental therapies that use electrical nerve stimulation to treat lower urinary tract dysfunction.MethodsClinical studies on established treatments such as percutaneous posterior tibial nerve stimulation (P-PTNS), transcutaneous electrical nerve stimulation (TENS), sacral nerve stimulation (SNS) and sacral anterior root stimulation (SARS) are evaluated. In addition, clinical evidence from experimental therapies such as dorsal genital nerve (DGN) stimulation, pudendal nerve stimulation, magnetic nerve stimulation and ankle implants for tibial nerve stimulation are evaluated.ResultsSNS and P-PTNS have been investigated with high-quality studies that have shown proven efficacy for the treatment for overactive bladder (OAB). SARS has proven evidence-based efficacy in spinal cord patients and increases the quality of life. TENS seems inferior to other OAB treatments such as SNS and P-PTNS but is noninvasive and applicable for ambulant therapy. Results from studies on experimental therapies such as pudendal nerve stimulation seem promising but need larger study cohorts to prove efficacy.ConclusionNeurostimulation therapies have proven efficacy for bladder dysfunction in patients who are refractory to other therapies.SignificanceRefinement of neurostimulation therapies is possible. The aim should be to make the treatments less invasive, more durable and more effective for the treatment of lower urinary tract dysfunction.

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Unilateral versus bilateral stage I neuromodulator lead placement for the treatment of refractory voiding dysfunction

Abstract: Bilateral stage I neuromodulation trial provides a significantly higher rate of improvement in refractory voiding symptoms to allow for the progress to stage II implantation.

Cited by 33 publications

References 8 publications

Sacral neuromodulation outcomes for the treatment of refractory idiopathic detrusor overactivity stratified by indication – lack of anticholinergic efficacy versus intolerability

Sacral neuromodulation outcomes for the treatment of refractory idiopathic detrusor overactivity stratified by indication – lack of anticholinergic efficacy versus intolerability

Sacral neuromodulation in overactive bladder: a review and current perspectives

Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives

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