International Continence Society best practice statement for use of sacral neuromodulation

Goldman, Howard B.; Lloyd, Jessica; Noblett, Karen; Carey, Marcus; Castaño, Juan Carlos; Gajewski, Jerzy; Lehur, P.‐A.; Hassouna, Magdy; Matzel, Klaus E.; Paquette, Ian M.; Wachter, Stefan De; Ehlert, Michael; Chartier‐Kastler, Emmanuel; Siegel, Steven

doi:10.1002/nau.23515

Cited by 138 publications

(100 citation statements)

References 167 publications

(361 reference statements)

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“…In the literature, prognostics factors are scarce. In recent recommendations concerning SNM, Goldman et al 17 advised that only the test phase could predict the success of SNM. Indeed, neither urodynamic data nor previous BoNT-A injections have been identified as a predictive A, Discontinuation-free survival.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Baron

Perrouin-Verbe

Lacombe³

et al. 2020

Neurourology and Urodynamics

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Introduction Management of idiopathic overactive bladder (iOAB) after the failure of sacral nerve modulation (SNM) is very challenging. To the best of our knowledge, no study has evaluated the use of botulinum toxin A (BoNT‐A) after SNM failure for iOAB. The aim of this study is to evaluate the tolerance and efficacy of BoNT‐A injection after the failure of SNM for iOAB. Methods We conducted a retrospective multicentric analysis of all patients who had received either onabotulinumtoxinA or abobotulinumtoxinA intradetrusor injection for iOAB after SNM failure, between January 2004 and December 2017. The primary outcome was the percentage of success of first BoNT‐A injection (either resolution of their urinary incontinence or their frequency or more than 50% reduction in frequency). Secondary outcomes were results of urodynamic studies, complications, total number of injections, causes of withdrawal, and subsequent treatment. Results Seventy‐six patients (62 female) were included. The percentage of success of first BoNT‐A injection was 43.4% (n = 33). All overactive bladder symptoms were significantly improved on the 3‐day bladder diary. Twenty‐eight patients (36.8%) were put under clean intermittent self‐catheterization transitory. After a mean follow‐up of 57.7 (±38.5) months, median number of injections was 2 (1‐15). Overall, 42 patients (55.2%) stopped injections during follow‐up. The estimated 36‐months discontinuation‐free rate was 48.1%. Mean cause of discontinuation was a primary failure (n = 32; 42.1%). Conclusion BoNT‐A can be used in SNM nonresponders with a success rate of 43.4% but is associated with a high long‐term discontinuation rate.

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Section: Discussionmentioning

confidence: 99%

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Baron

Perrouin-Verbe

Lacombe³

et al. 2020

Neurourology and Urodynamics

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“…25 How these changes occur is less well understood, and primarily thought through changes in the pudendal afferent nervous system. 4 Since the presence of the PFM contraction is the most appropriate parameter for determining a successful implant, 2,26 and the PFM contraction results from direct efferent stimulation of the pelvic floor, changes in the pelvic floor could be the initiator for the observed central changes. Further studies evaluating changes in the PFM responses during the test phase are ongoing to determine if they can serve as a putative physiological biomarker of treatment response.…”

Section: F I G U R E 2 Correlation Between Vpfmr and Epfmrs Recorded mentioning

confidence: 99%

Neural pathway of bellows response during SNM treatment revisited: Conclusive evidence for direct efferent motor response

Vaganée

Voorham

Panicker

et al. 2020

Neurourology and Urodynamics

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Background In sacral neuromodulation (SNM) patients, it is thought the bellows response elicited upon sacral spinal nerve stimulation is reflex‐mediated. Therefore the mechanism of action of SNM is considered to be at the spinal or supraspinal level. These ideas need to be challenged. Objective To identify the neural pathway of the bellows response upon sacral spinal nerve stimulation. Design, Setting, and Participants Single tertiary center, prospective study (December 2017‐June 2019) including 29 patients with overactive bladder refractory to first‐line treatment. Intervention Recording of the pelvic floor muscle response (PFMR) using a camcorder and electromyography (EMG) (intravaginal probe and concentric needles) upon increasing stimulation during lead or implantable pulse generator placement. Outcome Measurements and Statistical Analysis The lowest stimulation intensity needed to elicit a visual PFMR and electrical PFMR was determined. Electrical PFMRs were subdivided according to their latency. Outcome: the association between visual and electrical PFMRs. Statistical analyses were performed using the weighted kappa coefficient. Results Three different electrical PFMRs could be identified by surface and needle EMG, corresponding with a direct efferent motor response (R1), oligosynaptic (R2), and polysynaptic (R3) afferent reflex response. Only the R1 electrical PFMR was perfectly associated with the visual PFMR (κ = 0.900). Conclusions The visual PFMRs upon sacral spinal nerve stimulation are direct efferent motor responses. A reopening of the discussion on the mechanism of action of SNM is possibly justified.

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“…SNM is a minimally invasive fully reversible therapy that was approved by the US Food and Drug Administration (FDA) in 1997 for refractory OAB. SNM is defined as a technique that electrically stimulates the third sacral spinal nerve root to modulate a neural pathway with the aim of treating bladder and/or bowel dysfunction [17]. The exact mechanism of action of SNM is unknown, however, it is believed to correct the balance between the peripheral sacral nerves and the central nervous system by stimulating the afferent sensory fibers of the pelvic and pudendal nerves [18].…”

Section: Introductionmentioning

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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International Continence Society best practice statement for use of sacral neuromodulation

Abstract: These guidelines undoubtedly constitute a reference document, which will help urologists, gynecologists, and colorectal surgeons optimize their use of SNM for refractory urinary urgency and frequency, UUI, NOR, and FI.

Cited by 138 publications

References 167 publications

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Neural pathway of bellows response during SNM treatment revisited: Conclusive evidence for direct efferent motor response

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

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