Long‐term results of sacral neuromodulation for women with urinary retention

Dasgupta, Ranan; Wiseman, Oliver; Kitchen, Neil; Fowler, Clare J.

doi:10.1111/j.1464-410x.2004.04979.x

Cited by 97 publications

(43 citation statements)

References 27 publications

(13 reference statements)

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“…Had we separated the neurogenic UR from idiopathic, non-obstructive UR in our analysis, we may have been able to show more meaningful outcomes. Recent reports on the e¡ect of SNS on idiopathic UR note improved success among patients with notable spasticity and hyperactivity of the pelvic £oor musculature [Swinn et al, 2000;Dasgupta et al, 2004].…”

Section: Discussionmentioning

confidence: 99%

“…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%

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

Sutherland

Lavers

Carlson³

et al. 2006

Neurourology and Urodynamics

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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Section: Discussionmentioning

confidence: 99%

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

125

View full text Add to dashboard Cite

show abstract

“…Latini et al 44 reported that 90% of patients maintained a 50% reduction of urge incontinence symptoms (median follow-up, ϳ1 year), and Siegel's group 45 reported that ϳ70% of their patients indicated an improvement of Ͼ50% (mean follow-up, 22 months). In women with retention due to Fowler's syndrome, nearly 80% of patients implanted were reported to have persistent benefit, 46 although 54% had required revision procedures. Some studies, however, have suggested a decline of effectiveness over time.…”

Section: Figmentioning

confidence: 99%

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Mayer

Howard

2008

Neurotherapeutics

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Summary:Voiding dysfunction, which includes incontinence, retention, and chronic pelvic pain, is a relatively frequent problem that can be difficult to manage. Neuromodulation via stimulation of the sacral nerves has been shown to improve thesesymptoms, although the exact mechanisms remain elusive. Techniques for nerve stimulation may vary, depending on the disease, location of pain, and the patient's anatomy. In addition to placement of electrodes on the sacral nerve roots, modulation has also been reported by peripheral branches of the sacral nerves including the pudendal and posterior tibial nerves. Newer surgical techniques have significantly decreased the morbidity of the procedures and increased the probability of a successful outcome.

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“…54 Different groups have published their long term results in recent years. [55][56][57] They all conclude that SNS therapy is safe and effective (Table I). …”

Section: Clinical Resultsmentioning

confidence: 99%

Sacral nerve stimulation for neuromodulation of the lower urinary tract

Oerlemans

Kerrebroeck

2007

Neurourology and Urodynamics

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Patients with symptoms of overactive bladder syndrome or non-obstructive urinary retention, refractory to conservative therapy, can nowadays be treated minimally invasively with sacral nerve stimulation (SNS). The use of electric currents to treat urological pathology has a long history but SNS therapy only received FDA approval in 1997. The mechanisms of action are still not known so there are different theories explaining the modulation effect. Recent studies have shown a central modulation effect. Predictive factors which can help to identify the perfect candidates are not known. Over the years the technique of SNS has become less invasive and because of two stage implantation test results have proven to be more reliable. The clinical results for this therapy have proven to be safe and effective and with the technical improvements over the years the re-operation and complication rates have decreased significantly. The clinical results have led to expanding indications because of positive effects in other symptoms. In the field of urology this has resulted in the use of SNS therapy for interstitial cystitis, neurogenic lower urinary dysfunction, and pediatric voiding dysfunction. In the field of gastro-intestinal pathology, SNS therapy is used to treat faecal incontinence and constipation.

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Long‐term results of sacral neuromodulation for women with urinary retention

Cited by 97 publications

References 27 publications

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

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

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Sacral nerve stimulation for neuromodulation of the lower urinary tract

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