Clinical outcome of sacral neuromodulation in incomplete spinal cord injured patients suffering from neurogenic lower urinary tract symptoms

Abstract

Objective: To determine the efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord injured (SCI) subjects affected by neurogenic lower urinary tract symptoms (NLUTS). Methods: Twenty-four SCI patients were enrolled. The individuals were divided into two groups: 13 individuals in the urinary retention category and 11 suffering from overactive bladder syndrome. All subjects underwent definitive SNM implantation (Medtronic, Inc.). Voiding symptoms were assessed using patient bladder diaries, which recorded both pre-SNM and before each follow-up (1, 3 and 6 months, and then every 6 months). Outcome measures were per 24 h: number of voids and voided volume per void for both groups; number of urinary leakages, pad use and nocturia for patients with overactive bladder syndrome; and volume per catheterization and number of catheterizations for urinary retention subjects only. Final checkups were completed by June 2008. Results: Median follow-up was 61 months. Up to the final visit, all subjects maintained a clinical improvement of more than 50% compared with baseline. Twenty-two side effects were recorded. Four subjects with urinary retention needed a new implant in the controlateral S3 sacral root because of loss of efficacy. One patient with urinary retention developed a wound infection at the implanted pulse generator site. Conclusions: Our study contains the largest series of implanted SCI patients ever published. SNM is a therapy to consider in the treatment of NLUTS for partial SCI patients, even if the loss of clinical benefits for patients with retentive NLUTS must be taken into account. All adverse events were treated effectively.

Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury

“…1 Recently it has been shown that incomplete spinal cord injury patients (SCIPs) make remarkable clinical improvements with sacral neuromodulation (SNM), either in neurogenic bowel symptoms (NBSs) or in neurogenic lower urinary tract symptoms (NLUTSs). 2,3 Moreover, literature reports SNM's positive clinical effects on erectile function in SCIP as well. 4 The aim of this study was to conduct medium and long follow-ups of SNM efficacy in SCIPs who had shown significant clinical improvement in more than one pelvic functional disturbance with a permanent SNM implant.…”

Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction

“…Our findings are in concordance with other studies reporting a loss of SNM efficacy in four patients in whom a worsening of the neurological status and technical problems could be ruled out. 17 Loss of SNM function seems to occur even more frequently in MS patients. Chaabane et al demonstrated a loss of SNM effect in 41% of the MS patients, most often because of progressive neurological disease.…”

“…In the patients with NDO combined with DSD, neither objective nor subjective SNM success was observed, whereas in patients with pure NDO, a significant decrease in incontinence and in urodynamic parameters could be observed. 17 Chaabane et al 18 presented a retrospective case series with 62 patients suffering from NLUTD: the majority from multiple sclerosis (MS) or incomplete SCI (13 patients each) and the remaining patients from various neurologic disorders. In their study, SNM led to a significant improvement not only of symptoms but also of urodynamic parameters including improvement of DSD in eight of nine patients.…”

A retrospective study on female urological surgeries over the 10 years following spinal cord lesion

“…3,17,18 However, the repetitive use of endoscopic detrusor injections of low dosages of BoNT-A never required the use of AIC to increase the post-voiding residual urine ml -1 on the two patients who did not respond to first stage of SNM. In one patient, recurrence was observed after about 4 years.…”