Prolonged Sacral Neuromodulation Testing Using Permanent Leads: A More Reliable Patient Selection Method?

Kessler, Thomas M.; Madersbacher, H.; Kiss, Gustav

doi:10.1016/j.eururo.2004.11.005

Cited by 84 publications

(69 citation statements)

References 15 publications

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“…This is comparable to other studies in the literature that have shown that a staged implant technique improves the test stimulation response by minimizing technical failures, ultimately leading to a higher percentage of patients who have a pulse generator implanted [Scheepens et al, 2002b;Everaert et al, 2004;Kessler et al, 2005]. We utilized a test stimulation period of 7^14 days in our study with satisfactory results.…”

Section: Discussionsupporting

confidence: 74%

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: Discussionsupporting

confidence: 74%

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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“…Kessler et al 33 found that this increased the number of patients exhibiting a positive response, allowing generator implant to increase from ϳ50% to ϳ80% when the length of evaluation was extended from a period of 4 -7 days to at least 2 weeks. Another report, also from Europe, also indicated that ϳ75% of patients undergoing a staged procedure did have a positive test, allowing implantation of a pulse generator, when the screening was performed for an average of 30 days.…”

Section: Surgical Techniquesmentioning

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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“…If the patient is considered eligible for definitive SNM, the implantable neurostimulator (INS) is inserted in a second stage. This procedure enables prolonged screening for up to 1 month, resulting in a success rate of approximately 80%, which is significantly higher than with PNE testing [23]. Before the introduction of the tined lead, the permanent lead was implanted under direct vision and in turn secured to the sacral periosteum during an open surgical technique.…”

Section: Technique Of Sacral Neuromodulationmentioning

confidence: 99%

“…However, due to the high risk of lead migration, the test duration is rather limited, and the reported success rate is between 40 and 50% [3]. Later, the two-stage implantation procedure was introduced, which enables screening with the permanent electrode during the first stage [23]. If the patient is considered eligible for definitive SNM, the implantable neurostimulator (INS) is inserted in a second stage.…”

Section: Technique Of Sacral Neuromodulationmentioning

confidence: 99%

Sacral neuromodulation for lower urinary tract dysfunction

Kerrebroeck

Marcelissen

2011

World J Urol

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Objectives To review the technique, indications, results and working mechanisms of sacral neuromodulation (SNM) for lower urinary tract dysfunction. Methods The available literature on SNM for lower urinary tract dysfunction was searched. Based on the information available in the literature and also based on personal experience, the urological indications, technique, mechanisms of action and results of SNM are presented and discussed. Results SNM for lower urinary tract dysfunction involves stimulation of the 3rd sacral nerve with an electrode implanted in the sacral foramen and connected to a pulse generator. The technique is accepted by the FDA since 1997. Currently, SNM for lower urinary tract dysfunction has been successfully used in about 26,000 patients with various forms of lower urinary tract dysfunction, including urgency, frequency and urgency incontinence as well as non-obstructive urinary retention. The actual procedure of SNM consists of a minimal invasive technique and is effective in about 70% of the patients who have been implanted with a permanent system. Also, in pelvic pain, interesting results have been described. SNM modulates the micturition reflexes at different levels in the central nervous system. Conclusions Sacral neuromodulation is a safe and effective therapy for various forms of lower urinary tract dysfunction, including urgency, frequency and urgency incontinence as well as non-obstructive urinary retention. It should be the first choice after failure of maximal conservative therapy.

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Prolonged Sacral Neuromodulation Testing Using Permanent Leads: A More Reliable Patient Selection Method?

Cited by 84 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

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Sacral neuromodulation for lower urinary tract dysfunction

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