Detrusor overactivity does not predict outcome of sacral neuromodulation test stimulation

Abstract

The aim of this study is to determine if urodynamic findings in patients with urge incontinence predicts response to sacral neuromodulation test stimulation. One hundred four patients with refractory urinary urge incontinence who had undergone sacral neuromodulation test stimulation were retrospectively reviewed. Pre- and post-test stimulation incontinence parameters and pelvic floor muscle (PFM) contraction strength was documented. Urodynamics were reviewed on all patients, and the presence or absence of detrusor overactivity (DO) was noted. Patients were then divided into two groups: responders to the test stimulation and non-responders. A positive response was considered to be a >or=50% improvement in the number of incontinent episodes per day (IE/day) and/or pad weight with test stimulation. Of the 104 patients evaluated, 64% (N = 67) responded to the test stimulation, while 36% (N = 37) were non-responders. The mean age was 59.7 and 67.0 among responders and non-responders (p = .01). There was a significant difference in the number of IE/day between non-responders and responders (p = .02). There was no relationship found between the presence or absence of DO and the likelihood for test stimulation success, patient demographics or pre test stimulation incontinence variables. Our study provides no statistically significant evidence that the presence or absence of DO on urodynamics predicts a response to sacral neuromodulation test stimulation. An important finding, however, was that patients without demonstrable DO on urodynamics may still have a positive response to sacral neuromodulation.

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

“…[123][124][125] The necessity to diagnose DO on UDS and its role in improving patient-related outcome measures needs to be evaluated in future diagnostic RCTs.…”

An update on sacral neuromodulation: where do we stand with this in the management of lower urinary tract dysfunction in 2010?

“…Bannowsky et al [64] reported that during PNE with a wire electrode or with a permanent electrode in patients with DO, the bladder capacity increased by 30% and 52%, respectively. The presence or absence of DO did not seem to predict the outcome of preimplant test-stimulation [31]. However, the pre-implant amplitude of the maximum overactive contraction and the mean pressure during the contraction was less in women who achieved detrusor stability after the implant [65].…”

“…South et al . [31] reported a significantly lower percentage of responders to PNE in patients aged > 65 years. They also found that ≤ 4 UI episodes/day were significantly associated with PNE-failure and that urodynamically confirmed detrusor overactivity (DO) in patients with refractory UUI does not predict the outcome of PNE.…”

Clinical Management of Bladder Dysfunction Caused by Sexual Abuse

“…Thus, patients undergo at least two minimally invasive procedures. In most studies, success rates of test stimulation with temporary leads as used by our group (PNE testing) vary between 49 and 65% [13,14] . The excellent test results in our group of patients (success in all patients tested), which stand in contrast to the short time of successful neuromodulation with the permanent device (all implants had to be revised and finally removed) implies that multiple factors may have influenced the test results.…”