Sacral Neuromodulation in Patients With Neurogenic Lower Urinary Tract Dysfunction: A Multicenter Retrospective Study From China

Masood, Ifrah; Chen, Qi; Li, Jiayi; Xu, Zhihui; Ying, Xiaoqian; Wang, Yiming; Liu, Limin

doi:10.1111/ner.13383

Cited by 15 publications

(5 citation statements)

References 15 publications

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“…Our cohort study demonstrated that EA could reduce PVR by 50% or more and restore satisfactory spontaneous urination (PVR <100 mL) in 70.0% (14/20) of the patients with CUR resulting from LNML secondary to lumbosacral or pelvic tumor resection surgeries. A retrospective study from China reported that after SNM therapy, 75.3% of patients with subspinal and peripheral nervous system lesions had PVR reduced by at least 50% ( 31 ), which was closely equal to EA’s efficacy presented in our study. In addition, according to time-to-event analysis we found that with EA treatment of 8 weeks or longer, more than 50% patients could respond.…”

Section: Discussionsupporting

confidence: 82%

Effects of electroacupuncture on chronic urinary retention after pelvic or lumbosacral tumor resection surgeries: a retrospective cohort study

Yang,

Zhu,

Yao

et al. 2024

Transl Androl Urol

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Background Chronic urinary retention (CUR) resulting from lower motor neuron lesions (LMNL) is a medical condition secondary to pelvic or lumbosacral tumor resection surgeries. Electroacupuncture (EA) is proved to be effective and safe in treating certain lower urinary tract disorders. However, the clinical benefit and optimal duration of EA treatment for CUR following LMNL remain unknown. Methods Using a retrospective cohort design, 20 eligible patients diagnosed with CUR resulting from LMNL secondary to pelvic or lumbosacral tumor resection surgeries were included from March 1, 2017, to June 30, 2020. The patients were treated by EA three times a week for 2 to 12 weeks and followed up for 24 weeks after treatment. The electric stimulators with a 5-Hz continuous wave (5–10 mA intensity) were separately connected to bilateral Ciliao (BL32), bilateral Zhongliao (BL33), and bilateral Huiyang (BL35), and stimulators with a 10-Hz continuous wave (1–2 mA intensity) were connected to bilateral Sanyinjiao (SP6). Current intensity was adjusted according to the patients’ individual tolerance. The median follow-up was 32 weeks (range, 26–36 weeks). Responders were defined as patients whose post-void residuals (PVR) reduced by 50% or more from baseline. Adverse event was recorded. Results Totally 20 patients [mean (standard deviation) age, 48.1 (15.5) years; 9 men (45.0%); 11 women (55.0%)] were included. Of the 20 patients, 14 (70.0%) had responded to EA treatment and stopped catheterization for achieving satisfactory spontaneous urination (PVR <100 mL without complications), 7 (35.0%) had complete resolution (90–100% reduction in PVR from baseline), and 13 (65.0%) scored 1 (much better) or 2 (moderately better) in the Patient Global Impression of Improvement (PGI-I) assessment. Moreover, 6 (30.0%) patients had responded within 4 weeks of EA treatment. According to Kaplan-Meier survival curve, we found that more than 50% patients could respond to EA treatment within 8 weeks or longer. None of the responders had ever experienced relapse in 24 weeks after EA treatment ended. None of the patients manifested urinary tract infection (UTI), newly diagnosed hydroureter or hydronephrosis. One patient diagnosed with hydronephrosis at baseline recovered after 12-week EA treatment. Two patients with UTI at baseline were prescribed antibiotics and did not present UTI again during the follow-up. Conclusions EA could be a promising treatment option for CUR caused by LMNL following pelvic or lumbosacral tumor resection surgeries, with long-term effects and a good safety profile. The optimal duration of EA should be of 8 weeks at least. But this was a retrospective cohort study of a small sample size, so future studies are needed to investigate EA in larger populations in randomized controlled trials.

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Section: Discussionsupporting

confidence: 82%

Effects of electroacupuncture on chronic urinary retention after pelvic or lumbosacral tumor resection surgeries: a retrospective cohort study

Yang,

Zhu,

Yao

et al. 2024

Transl Androl Urol

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“…To cure voiding dysfunction due to spinal cord lesions, sacral neuromodulation (SNM) system implantation is considered to be a safe and effective method in clinical practice. [13][14][15][16] Averbeck et al, reviewed recent literature and regarded SNM as a promising therapy for neurogenic lower urinary tract dysfunction in carefully selected patients with incomplete lesions. 17 rTMS was also attempted to treat UI.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Effect of rTMS on urinary incontinence in major vascular neurocognitive disorder

Ni,

Ke,

Tian

et al. 2024

F1000Res

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Background Urinary incontinence (UI) was an intractable symptom and many efforts had been made to combat this symptom over the past decades. Repetitive transcranial magnetic stimulation (rTMS) was used in many diseases for its focusing on neural network regulation. However, rTMS on the cortical urination center for acting on urination process remained further study. Case report A 67-year-old female farmer suffered from UI over two weeks. She was diagnosed with major vascular neurocognitive disorder. The patient received rTMS on the bilateral paracentral lobule. Stimulation was administered at 20 Hz with 25 stimulation trains of 30 stimuli each with a 30-second intertrain interval. After a 5-day course of rTMS intervention, the patient reported full awareness of her urination, but her neurocognitive decline had not improved at all. Conclusions In this case of UI with major vascular neurocognitive disorder, rTMS on the bilateral paracentral lobule was applied and therapeutic effect on UI was obvious.

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“…The results of our study are consistent with these findings. Masood et al 18 analyzed 152 patients with NB from four medical centers in China who underwent SNM and found that the postvoid residual volume significantly improved during the testing phase. The postvoid residual volume in the testing phase in our study improved significantly, and the results of the two studies were consistent.…”

Section: Discussionmentioning

confidence: 99%

Video-urodynamics efficacy of sacral neuromodulation for neurogenic bladder guided by three-dimensional imaging CT and C-arm fluoroscopy: a single-center prospective study

Shan

Zhu

Zhang

et al. 2022

Sci Rep

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To assess the efficacy of sacral neuromodulation (SNM) for neurogenic bladder (NB), guided by intraoperative three-dimensional imaging of sacral computed tomography (CT) and mobile C-arm fluoroscopy through video-urodynamics examination. We enrolled 52 patients with NB who underwent conservative treatment with poor results between September 2019 and June 2021 and prospectively underwent SNM guided by intraoperative three-dimensional imaging of sacral CT and mobile C-arm fluoroscopy. Video-urodynamics examination, voiding diary, quality of life questionnaire, overactive bladder symptom scale (OABSS) scoring, and bowel dysfunction exam were completed and recorded at baseline, at SNM testing, and at 6-month follow-up phases. Finally, we calculated the conversion rate from period I to period II, as well as the treatment efficiency and the occurrence of adverse events during the testing and follow-up phases. The testing phase of 52 NB patients was 18–60 days, with an average of (29.3 ± 8.0) days. Overall, 38 patients underwent SNM permanent electrode implantation, whose follow-up phase was 3–25 months, with an average of (11.9 ± 6.1) months. Compared with baseline, the voiding times, daily catheterization volume, quality of life score, OABSS score, bowel dysfunction score, maximum detrusor pressure before voiding, and residual urine volume decreased significantly in the testing phase. The daily voiding volume, functional bladder capacity, maximum urine flow rate, bladder compliance, and maximum cystometric capacity increased significantly in the testing phase. Besides, the voiding times, daily catheterization volume, quality of life score, OABSS score, bowel dysfunction score, maximum detrusor pressure before voiding, and residual urine volume decreased further from the testing to follow-up phase. Daily voiding volume, functional bladder capacity, maximum urine flow rate, bladder compliance, and maximum cystometric capacity increased further from testing to follow-up. At baseline, 10 ureteral units had vesicoureteral reflux (VUR), and 9 of them improved in the testing phase. Besides, there was 1 unit that further improved to no reflux during the follow-up phase. At baseline, 10 patients had detrusor overactivity (DO), and 8 of them improved in the testing phase. Besides, 1 patient’s symptoms further improved during the follow-up phase. At baseline, there were 35 patients with detrusor-bladder neck dyssynergia (DBND); 14 (40.0%) of them disappeared during the testing phase. Among 13 cases who had DBND in the testing phase, 6 (46.2%) disappeared during the follow-up phase. Of the 47 patients with detrusor-external sphincter dyssynergia (DESD) at baseline, 8 (17.0%) disappeared during the testing phase. Among 26 cases who had DESD in the testing phase, 6 (23.1%) disappeared during the follow-up phase. The effective rate of this study was 88.5% (46/52), and the conversion rate from phase I to phase II was 73.1% (38/52). Additionally, the efficacy in a short-term follow-up was stable. SNM guided by intraoperative three-dimensional imaging of sacral CT and mobile C-arm fluoroscopy is an effective and safe treatment option for NB in short time follow-up. It would be well improved in the bladder storage function, sphincter synergetic function and emptying efficiency by video-urodynamics examination in this study.Trial registration: Chinese Clinical Trial Registry. ChiCTR2100050290. Registered August 25 2021. http://www.chictr.org.cn/index.aspx.

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Sacral Neuromodulation in Patients With Neurogenic Lower Urinary Tract Dysfunction: A Multicenter Retrospective Study From China

Cited by 15 publications

References 15 publications

Effects of electroacupuncture on chronic urinary retention after pelvic or lumbosacral tumor resection surgeries: a retrospective cohort study

Effects of electroacupuncture on chronic urinary retention after pelvic or lumbosacral tumor resection surgeries: a retrospective cohort study

Case Report: Effect of rTMS on urinary incontinence in major vascular neurocognitive disorder

Video-urodynamics efficacy of sacral neuromodulation for neurogenic bladder guided by three-dimensional imaging CT and C-arm fluoroscopy: a single-center prospective study

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