Sacral Neuromodulation for Women with Fowler&amp;rsquo;s Syndrome

Swinn, M.; Kitchen, Neil; Goodwin, Robert J.; Fowler, Clare J.

doi:10.1159/000020321

Cited by 101 publications

(55 citation statements)

References 11 publications

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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%

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%

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

“…The success of neuromodulation in this group, which is often refractory to other treatment, 40 was reported to be 68%. 41 Another investigation found a successful outcome in 22 of 28 patients with retention (78%). 42 Urodynamic studies confirm beneficial results treating patients with idiopathic retention, with postvoid residuals becoming minimal and uroflometry and pressure flow studies returning to near normal values.…”

Section: Figmentioning

confidence: 97%

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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“…This leads to complex repetitive discharges and decelerating bursts, preventing a complete relaxation of the urethral sphincter. Until recently, the only effective management was CISC; sacral neuromodulation has shown promise [2]. In the present patient with Fowler's syndrome, treating the insulin resistance had direct (return of spontaneous voiding) and indirect bene®ts, including weight loss, correction of abnormal triglyceride/lipoprotein metabolism and the resultant reduction in cardiovascular risk factors [3].…”

mentioning

confidence: 84%

Fowler's syndrome: cause or consequence of insulin resistance?

Lee

Patel²,

Copland

et al. 2002

BJU Int

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A 26-year-old woman with polycystic ovarian syndrome (PCOS) presented with recurrent urinary retention. A neurological examination, cystoscopy and upper tract imaging were normal. EMG of the urethral sphincter revealed a typical trace for Fowler's syndrome. She was not suitable for sacral neuromodulation because of her physique and high body mass index, so CISC was commenced. Further investigations showed the metabolic form of PCOS, with insulin resistance, compensatory hyperinsulinaemia and impaired glucose tolerance. Oral metformin (an insulin-sensitizing agent) was commenced, with a dramatic reduction in weight and return of spontaneous voiding. CommentFowler's syndrome comprises abnormal EMG activity of the urethral sphincter, voiding dysfunction and PCOS [1]. The abnormal EMG activity consists of an ephaptic spread of excitation between muscle ®bres, rather than from terminal branches of the motor axon. This leads to complex repetitive discharges and decelerating bursts, preventing a complete relaxation of the urethral sphincter. Until recently, the only effective management was CISC; sacral neuromodulation has shown promise [2]. In the present patient with Fowler's syndrome, treating the insulin resistance had direct (return of spontaneous voiding) and indirect bene®ts, including weight loss, correction of abnormal triglyceride/lipoprotein metabolism and the resultant reduction in cardiovascular risk factors [3]. A randomized controlled trial would con®rm the therapeutic potential of screening for and treating the insulin resistance in Fowler's syndrome. We recommend an endocrinological opinion in this unusual patient group.

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Sacral Neuromodulation for Women with Fowler’s Syndrome

Cited by 101 publications

References 11 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

Fowler's syndrome: cause or consequence of insulin resistance?

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