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

Abstract

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

A systematic review of clinical studies of electrical stimulation for treatment of lower urinary tract dysfunction

“…From an initial 456 publications identified by the literature search, 73 articles were included, of which 8 are randomized controlled trials (RCTs) [7][8][9][10][11][12][13][14], 7 are comparative studies [15][16][17][18][19][20][21], 46 are prospective and 10 are retrospective case series [68][69][70][71][72][73][74][75][76][77], and 2 combine prospective and retrospective case series in the same article [78,79]. The screening process is summarized in Fig.…”

“…These studies were published between the years of 1993 and 2009 and include 5 RCTs [9-11, 13, 14], 23 prospective [24, 25, 27-30, 32, 34, 35, 37, 41, 42, 44, 46, 48, 56, 58, 61-66] and 10 retrospective case series [68][69][70][71][72][73][74][75][76][77], and 2 combined prospective/retrospective case series [78,79]. UUI was the most common indication studied: 34 studies included patients with UUI symptoms and 11 studies investigated this population exclusively.…”

“…In 2003, Spinelli et al published a description of a twostage implantation procedure [48], and 13 of the articles dating back to December 2002 [46,48,56,61,62,64,66,71,[73][74][75][76][77] Excluded reports (n=147) not meeting inclusion criteria, e.g., non-English, abstractonly, reviews Fig. 1 Flow diagram for screening process employed (6 of these investigated both one-stage and twostage implantation outcomes).…”

“…An intention to treat analysis was possible for only 8 (20%) [27,32,44,48,52,64,71,74] of the 40 studies of implantable SNS. Since RCTs randomized only patients with successful test stimulation results, these studies were not amenable to analysis.…”

Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation

“…Because of its proven effectiveness, the search to expand the indications for SNM in complex patient populations is inevitable. Two studies have shown that SNM is effective in the treatment of de novo or worsening OAB after SUI surgery [13,14]. The study by Sherman et al [13] noted that 26% of patients had undergone a sling release procedure and found that this parameter was not predictive of response to SNM.…”