What uro-gynecologists should know about sacral neuromodulation (SNM) for the treatment of refractory overactive bladder

Oelke, Matthias; Addali, M.; Reisenauer, Christl

doi:10.1007/s00404-019-05127-7

Cited by 7 publications

(5 citation statements)

References 55 publications

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“…a drop in the number of urgency, frequency or UUI episodes by half or more), and positive responders were offered a permanent implant. During stage 2, a battery-powered implantable pulse generator (IPG) was positioned in the fatty tissue of the gluteal region on the side of the electrode and connected to the test electrode under general anesthesia or analgesic sedation [30].…”

Section: Snmmentioning

confidence: 99%

Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study

Kaaki

Gupta²

2020

PLoS ONE

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Background Sacral neuromodulation (SNM) is a minimally invasive fully reversible therapy that was approved in 1997 for overactive bladder syndrome (OAB) refractory to behavior modification and pharmacotherapy. Despite being in use for over two decades, the data on medium to long-term safety and efficacy of SNM in OAB is limited. We investigated the medium-term efficacy and safety of SNM along with the predictive factors for its success in patients with refractory OAB. Methods A retrospective consecutive case series of 66 patients undergoing SNM for refractory OAB between July 2009 and July 2018. All patients underwent a test period followed by permanent implantation, if there was > = 50% improvement in any symptom. The primary outcome was "success" defined as > = 50% improvement in any clinical parameter based on the subjective assessment of patient's response. The secondary outcomes were number of pads used in 24 hours, post-operative complications and re-operation rates. Results 66 females with an average age of 62.7 years were included. 55/66 patients (83.3%) had a successful test phase and underwent permanent implantation. After a median follow-up of 32 months, SNM was successful in 41/55 (74.5%) patients. Mean number of pads used in 24 hours decreased significantly from 3.5 preoperatively to 1.2 at last follow-up (p<0.001). 8/55 (14.5%) patients reported complications of pain, lead migration, wound dehiscence and device malfunction. 10/55 (18.2%) patients underwent revision surgeries after a median duration of 21.9 months. Device was explanted in 15/55 (27.3%) patients after a median duration of 24 months. No significant predictor for success was identified.

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Section: Snmmentioning

confidence: 99%

Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study

Kaaki

Gupta²

2020

PLoS ONE

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“…Many of them were put on sacral neuromodulation; however, a possible pregnancy could limit this kind of therapy. Due to insufficient data and the lack of consensus among experts, it is currently recommended to deactivate the device during pregnancy [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Sacral Neuromodulation in Pregnant Women—A Case Report and Literature Review

Szymański

Słabuszewska-Jóźwiak

Jakiel

2022

IJERPH

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Millions of women around the world suffer from an overactive bladder and urinary retention. A significant number of them are of reproductive age. For 25 years, SNM has been an effective therapy for treatment-resistant hyperactive bladder and idiopathic urinary retention. The paper presents a case of a 35-year-old pregnant woman with an overactive bladder resistant to pharmacological treatment, who responded positively to sacral neuromodulation. The patient decided against deactivating the neuromodulator and, after an uneventful course of pregnancy, she gave birth by a caesarean section to a healthy female infant. The use of SNM in pregnant patients remains a constant clinical challenge. The current literature was reviewed, but published studies do not provide a clear answer. Further studies with a long follow-up period are necessary to determine more accurately the effects of SNM therapy on the fetus and the course of pregnancy. Currently, it is recommended to deactivate SNM during pregnancy. However, it seems that an individual approach to the patient with information on the risks and benefits of continuing or discontinuing therapy should be the current procedure.

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“…Recently, sacral neuromodulation is widely reported, however it is only the second-line treatment of refractory OAB [45]. The first-line treatment of OAB is still pharmacotherapy [45–47]. Acetylcholine is the main neurotransmitter in the DSM.…”

Section: Discussionmentioning

confidence: 99%

Attenuated BK channel function promotes overactive bladder in a rat model of obesity

Ding

Zhang

et al. 2019

Aging

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Overactive bladder (OAB) is mostly observed in obese individuals, and is associated with enhanced excitability and contractility of the detrusor smooth muscle (DSM). Large-conductance voltage- and Ca2+-activated K+ (BK) channels reduce the excitability and contractility of the DSM. We tested whether obesity-induced OAB is associated with altered BK channel expression and activity in the DSM. Seven-week-old female Sprague-Dawley rats (N=80) were fed a normal or high-fat diet (HFD) for 12 weeks. HFD-fed rats exhibited a higher average bodyweight and urodynamically established detrusor overactivity. mRNA levels of the Kcnma1 (BKα subunit) and Kcnmb1 (BKβ1 subunit) in whole tissues and cells from the DSM were reduced in HFD-fed rats. A selective BK channel opener, NS1619, was then applied to DSM cells from the two groups of rats. Patch-clamp techniques revealed that spontaneous transient outward currents, NS1619-induced activation of spontaneous transient outward currents, and whole-cell BK currents, as well as NS1619-induced membrane hyperpolarization, were attenuated in DSM cells from HFD-fed rats. The relaxation effect of NS1619 on contractility was reduced in DSM strips from HFD-fed rats. Thus, impaired expression of Kcnma1 and Kcnmb1 in the DSM contributes to obesity-induced OAB, suggesting that BK channels could be a useful treatment targets in OAB.

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What uro-gynecologists should know about sacral neuromodulation (SNM) for the treatment of refractory overactive bladder

Cited by 7 publications

References 55 publications

Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study

Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study

Sacral Neuromodulation in Pregnant Women—A Case Report and Literature Review

Attenuated BK channel function promotes overactive bladder in a rat model of obesity

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