Sacral neuromodulation: new applications in the treatment of female pelvic floor dysfunction

Pettit, Paul; Thompson, Jason; Chen, Anita H.

doi:10.1097/00001703-200210000-00014

Cited by 57 publications

(28 citation statements)

References 24 publications

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“…A number of randomized, multi-center trials have demonstrated the e¡ectiveness and durability of sacral neuromodulation in the treatment of refractory voiding dysfunction [Schmidt et al, 1999;Hassouna et al, 2000;Siegel et al, 2000;Janknegt et al, 2001]. Furthermore, the role of sacral neuromodulation in treating other pelvic £oor disorders including interstitial cystitis, pelvic pain syndromes, and bowel dysfunction have shown encouraging results but require statistically powered multi-center trials with longer follow up [Pettit et al, 2002;Bernstein and Peters, 2005]. As indications for SNS continue to expand, it is likely that pelvic neuromodulation will continue to play an integral role in the management of a variety of refractory voiding disorders.…”

Section: Discussionmentioning

confidence: 99%

“…There are several explanations for this observation. First of all, there is a 16.4% long-term failure rate with a staged implant, which may be due to an initial placebo e¡ect during the test stimulation period [Pettit et al, 2002]. As a result, the optimal screening period has not yet been de¢nitively determined, but most studies use a period of 7^14 days.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…urinary incontinence, urgency-frequency syndromes and unobstructive urinary retention, translate into a significant burden both in cost and quality-of-life issues for women and men. Sacral nerve stimulation (SNS) involves the stimulation of the sacral nerves to modulate the neural reflexes that influence the bladder, urethral sphincter and pelvic floor [1]. In the early 1980s, the work of Schmidt and Tanagho [2,3] showed that electrical stimulation of the sacral nerve root could reduce inappropriate neural activity, thereby inhibiting the overactive detrusor.…”

Section: Introductionmentioning

confidence: 99%

Re‐operation rates after permanent sacral nerve stimulation for refractory voiding dysfunction in women

et al. 2008

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and analysis of variance were used to compare the results. RESULTSIn all, 95 patients had 105 test procedures; 30 peripheral nerve evaluation (PNE) and 75 staged tined leads. Response rates were lower in the PNE than in the tined lead (40% vs 67%, P = 0.01). The indication for SNS was associated with the response rate, with urinary retention having the highest response (71%, P = 0.01). For the 55 implanted devices, there were 18 revisions (33%) and eight explants (15%). The main reasons for revision or explants were loss of efficacy (16/26) and pain at the implant site (six of 26). The median (range) time to intervention after implantation was 17 (1.2-75.0) months, and this was significantly associated with the indication. Revisions due to pain at the implant site were within the first year, and reoperations due to loss of efficacy after 1-2 years, whereas battery replacement was required on average 4 years after initial implantation. CONCLUSIONSThis study confirms the higher response rates of the tined-lead staged technique over PNE. Unobstructive urinary retention had the highest response rates. The reason for revision appeared to be largely predicted by the length of time since implantation. KEYWORDSInterStim, urinary incontinence, urinary retention, interstitial cystitis, overactive bladder, adverse effects Study Type -Therapy (outcomes research) Level of Evidence 2c

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“…Stimulation of sacral nerves, specifically S3 has shown results for urinary incontinence secondary to detrusor hyper relfexia, interstitial cystitis, faecal incontinence and in refractory pelvic pain conditions [14]. The selection criteria and methodology of implantation is addressed more elaborately in specific literature.…”

Section: Miscellaneous Conditionsmentioning

confidence: 99%

Spinal Cord Stimulation What Do We Know?

Mahalle¹

2016

JACCOA

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Neurochemical effects:There is no relation between SCS and opioid release, there is an increase dorsal horn GABA expression seen in animal model after SCS stimulation, levels of Substance P and serotonin are shown to be elevated by SCS. Studies have proven that excitatory amino acid release is suppressed by SCS via action on GABA-B receptors and intra-thecal adenosine as well baclofen may potentiate the effect of SCS. The net effect of these neurochemical effects reduces dorsal horn neuronal excitability [3].

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Sacral neuromodulation: new applications in the treatment of female pelvic floor dysfunction

Abstract: While the data are encouraging in these new arenas of pelvic floor disorders, investigators acknowledge the need for multicenter, statistically powered studies to evaluate the validity of these findings.

Cited by 57 publications

References 24 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

Re‐operation rates after permanent sacral nerve stimulation for refractory voiding dysfunction in women

Spinal Cord Stimulation What Do We Know?

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