Long&amp;ndash;Term Effectiveness of Sacral Nerve Stimulation for Refractory Urge Incontinence

Janknegt, R. A.; Hassouna, Magdy; Siegel, Steven; Schmidt, Richard A.; Gajewski, Jerzy; Rivas, David A.; Elhilali, Mostafa; Milam, Douglas C.; Kerrebroeck, Philip E. V. A. Van; Dijkema, H.E.; Nÿeholt, A.A.B. Lycklama à; Fall, Magnus; Jonas, Udo; Catanzaro, F.; Fowler, Clare J.; Oleson, Kimbery A.

doi:10.1159/000052420

Cited by 126 publications

(74 citation statements)

References 15 publications

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“…Furthermore, it is felt that neuromodulation treats bladder overactivity via its a¡ects on the activity and basal tone of the pelvic £oor [Schmidt et al, 1999]. A number of randomized, multi-center trials have demonstrated the e¡ectiveness and durability of sacral neuromodulation in the treatment of refractory voiding dysfunction [Schmidt et al, 1999;Hassouna et al, 2000;Siegel et al, 2000;Janknegt et al, 2001]. Furthermore, the role of sacral neuromodulation in treating other pelvic £oor disorders including interstitial cystitis, pelvic pain syndromes, and bowel dysfunction have shown encouraging results but require statistically powered multi-center trials with longer follow up [Pettit et al, 2002;Bernstein and Peters, 2005].…”

Section: Discussionmentioning

confidence: 99%

“…The durable safety and e⁄-cacy of sacral neuromodulation with respect to these three conditions has been demonstrated in several long-term clinical studies Janknegt et al, 2001]. Furthermore, the permanent quadripolar tined lead was introduced in 2003 which allowed percutaneous lead implantation without the need for incision or additional fascial anchoring [Spinelli et al, 2003].Thus, sacral neuromodulation has emerged as a minimally invasive salvage therapy for patients with the aforementioned conditions.…”

Section: Introductionmentioning

confidence: 99%

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Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Starkman

Wolter

Scarpero

et al. 2006

Neurourology and Urodynamics

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Aims: We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods: A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: signi¢cant response (80% improvement), moderate response (50% and <80% improvement), and poor response (<50% response). Results: Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal ¢stula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no signi¢cant di¡erences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion: Sacral neuromodulation appears to be an e¡ec-tive therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality. Neurourol. Urodynam. 26: 29^35, 2007. ß 2006

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Starkman

Wolter

Scarpero

et al. 2006

Neurourology and Urodynamics

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“…Sacral nerve modulation (SNM) is a safe and minimally invasive treatment and it has become an option in refractory low urinary tract symptoms (LUTS) from different underlying diseases [13][14][15][16]; a number of prospective trials and numerous case series have provided an evidence base that has confirmed the efficacy and durability of SNM [17]. Despite the documented clinical benefit, the exact underlying neurophysiological mechanism of action of SNM is complex and not fully Journal of the Neurological Sciences 347 (2014) 257-261 understood.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of sacral nerve modulation in a series of multiple sclerosis patients with bladder dysfunction

Andretta

Simeone

Ostardo

et al. 2014

Journal of the Neurological Sciences

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Objective: Bladder dysfunctions are common in multiple sclerosis (MS) often causing the most distressing symptoms. The aim of this paper was to evaluate the effectiveness of sacral nerve modulation (SNM) in this disease. Methods: We conducted an observational retrospective survey in 17 patients treated with SNM in the north-east of Italy, all complaining of bladder symptoms (storage in 41%, voiding in 24%, mixed in 35%) unresponsive to conventional therapies, with a mean follow-up of 52 ± 26 months and mean Expanded Disability Status Scale score of 5.8 ± 1.8. Results: 75% of patients reported significant and lasting improvement in bladder symptoms and in quality of life. We observed a statistically significant improvement in frequency, urgency, number of pads, residual volumes, number of catheterizations and in the voided volumes. In 5 out of 6 cases with mixed symptoms the stimulation was discontinued (device totally explanted or turned off) after a mean time of 66 months (range 10-84 months) after the implant, for disease progression or loss of efficacy. Conclusion: SNM could be an option in very selected cases of storage and voiding symptoms refractory to conservative treatments caused by a stable or slowly progressive MS considering its minimal invasiveness and reversibility. The poor results observed suggest avoiding this therapy in mixed symptoms and in cases of advanced disability.

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“…Although the mechanism of action is not fully understood, voiding dysfunction at both extremes of U/F and UR seem to respond well, with long-term success and safety noted by numerous studies [Bosch and Groen, 2000;Chartier-Kastler et al, 2000;Hassouna et al, 2000;Siegel et al, 2000;Janknegt et al, 2001;Jonas et al, 2001;Dasgupta et al, 2004;Brazzelli et al, 2006]. Other pathological conditions within the pelvis have also appreciated bene¢t from SNS therapy, to include chronic pelvic pain, constipation/obstipation, irritable bowel syndrome, and fecal incontinence Kene¢ck and Christiansen, 2004;Peters and Konstandt, 2004;Bernstein and Peters, 2005;Jarrett, 2005].…”

Section: Introductionmentioning

confidence: 99%

Sacral nerve stimulation for voiding dysfunction: One institution's 11‐year experience

Sutherland

Lavers

Carlson³

et al. 2006

Neurourology and Urodynamics

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125

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Aim: The purpose of this study was to review our institution's 11-year experience with SNS for the treatment of refractory voiding dysfunction. Dating back to 1993, it covers a span of time which describes the evolution of SNS as it includes PNE trials, non-tined (bone-anchored or fascial-anchored) leads, percutaneous tined leads with two-staged procedures, and even percutaneous pudendal trials. Methods: A retrospective review was performed on SNS patients who received an implantable pulse generator (IPG) in our practice from 12/1993 to 12/2004. After Institutional Review Board approval, consents for chart review were obtained from 104 patients, representing 44% of this neuromodulatory patient population. Results: Of our population, 87% were female and 13% were male. Average age at implant was 50 years AE 13.4 years. Duration of symptoms before implantation was 116 months (range 9^600 months). Eighty percent were implanted for a predominant complaint of urinary urgency and frequency (U/F). Overall, 22% had U/F only, 38% had concomitant urge incontinence (UI), and 20% had concomitant mixed incontinence (MI). Twenty percent were treated for non-obstructive urinary retention (UR), with half of these associated with a neurogenic etiology. Additionally, 46.2% had pelvic pain, 58.6% had bowel complaints, and 51% reported sexual dysfunction. In patients with U/F, mean voiding parameters as described by pre-implant voiding diaries revealed the following: 12.4 (AE5.1) voids per 24 hr; 2.3 (AE1.8) voids per night; 5.0 (AE4.7) leaks per 24 hr; and 2.3 (AE2.6) pads per 24 hr. Statistically signi¢cant improvements post-implantation were noted with mean decreases in the following: 4.3 voids per 24 hr; 1.0 void per night; 4.4 leaks per 24 hr; and 2.3 pads per 24 hr (all P < 0.05). In the UR group a statistically signi¢cant improvement post-implantation was noted only in voids per night, with a mean decrease of 0.8 (P < 0.05). With a mean follow up of 22 months (range 3^162 months), sustained subjective improvement was >50%, >80%, and >90% in 69%, 50%, and 35% of patients, respectively. By quality of life survey, 60.5% of patients were satis¢ed and 16.1% were dissatis¢ed with current urinary symptoms. Only 13% (14 patients) abandoned therapy, making up a signi¢cant portion of those dissatis¢ed with current urinary symptoms. Good overall lead durability was seen (mean 22 months, range 1^121 months), with the ¢rst successful lead proving to be the most durable (mean 28 months, range 1.41 20 months). Lead durability decreased progressively with subsequent trials. Overall, 53% of patients experienced at least one reportable event (RE) attributable to either lead or IPG. A total of 126 REs were noted, with 97% mild-to-moderate in severity. REs included lack of e⁄cacy, loss of e⁄cacy, infection, hematoma/seroma, migration, pain, undesirable change in sensation, and device malfunction. In this population, 47.1% of leads were tined while 52.9% were non-tined. Tined leads had an overall lower RE rate as compared to non-tined leads: 28% ...

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Long–Term Effectiveness of Sacral Nerve Stimulation for Refractory Urge Incontinence

Cited by 126 publications

References 15 publications

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Usefulness of sacral nerve modulation in a series of multiple sclerosis patients with bladder dysfunction

Sacral nerve stimulation for voiding dysfunction: One institution's 11‐year experience

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