Treatment of Urinary Voiding Dysfunction Syndromes With Spinal Cord Stimulation

Abstract

inary voiding dysfunction syndromes, including urge incontinence, urinary frequency and urinary retention, affect more than 33 million people in the United States. 1 Clinical presentation includes irritative symptoms of frequency and urgency with urge incontinence, obstructive symptoms including difficulty initiating and sense of incomplete emptying of the bladder, and urinary retention. 2 Sacral neuromodulation is a well-established treatment option for voiding dysfunction refractory to conservative therapies, including behavioral, medical, and uro-surgical treatment. 3,4 This case report presents a single patient with urinary incontinence who had previously undergone trial and implantation of InterStim therapy (Medtronic Neurological, Minneapolis, MN) (figure 1). The patient also had post-laminectomy syndrome with bilateral lower extremity pain and low back pain. Having failed all conservative treatment, she underwent spinal cord stimulation (SCS) trial and subsequent implantation. While using the SCS therapy, the patient had excellent relief of urinary incontinence symptoms and was able to discontinue use of InterStim therapy. We present the case of effective treatment of urinary voiding dysfunction symptoms, bilateral lower extremity pain and back pain with SCS. Case ReportThe patient was a 58-year-old woman (63 kg, 159 cm) with a history of postlaminectomy syndrome with intractable bilateral lower extremity pain and low back pain refractory to conservative therapies including caudal epidural injections, This case report presents the use of spinal cord stimulation (SCS) in a patient with urinary incontinence who had previously undergone trial and implantation of InterStim therapy (Medtronic Neurological, Minneapolis, MN). The patient also experienced bilateral lower extremity pain and low back pain related to post-laminectomy syndrome. Having failed all conservative treatment, the patient underwent SCS trial and subsequent implantation. In the postoperative period using SCS therapy, the patient had excellent relief of urinary incontinence symptoms, along with relief of low back pain and bilateral lower extremity pain and was able to discontinue use of InterStim therapy. For this patient, SCS was effective in controlling the urinary voiding dysfunction symptoms, bilateral lower extremity pain and back pain. The use of SCS to treat urinary incontinence problems deserves further study to explore its therapeutic potentials.

Coccygeal Fracture Pain Cured by Sacral Neuromodulation: A Case Report

“…At publication, patient was one year after implantation, only requiring occasional use of the stimulator and has rare symptoms, with her preinterstitial cystitis quality of life restored. A literature search for coccygeal fracture or neuromodulation revealed one case report of a female that had previously undergone InterStim implantation for urinary incontinence and also had bilateral lower extremity pain and back pain from postlaminectomy syndrome (10). In this case, however, the InterStim did not improve her pain, but instead they used SCS at levels T8-T9-T10 which helped both her urinary incontinence and relieved her pain completely.…”

Dorsal column stimulator applications

“…In this patient, SCS has been effective in controlling the urinary voiding dysfunction symptoms, but the use of SCS to treat these urinary voiding problems needs further investigation. [170]…”

Is there a link between back pain and urinary symptoms?

“…Another potential mechanism to explain this association is the common neurologic innervation (through S2‐4) of the lumbar spine and the lower urinary tract, which means that neurologic remodeling and reflex changes may lead to symptoms in both areas (viscerosomatic convergence) . Case reports of neuromodulation and epidural steroid injections improving both pain and urinary symptoms would support this . The increased muscle activity through the trunk due to low back pain may increase the intra‐abdominal pressure and weaken the pelvic floor, or low back pain may limit the ability of the pelvic floor to function properly.…”

“…34 Case reports of neuromodulation and epidural steroid injections improving both pain and urinary symptoms would support this. 35,36 The increased muscle activity through the trunk due to low back pain may increase the intra-abdominal pressure and weaken the pelvic floor, or low back pain may limit the ability of the pelvic floor to function properly. These mechanisms would explain urinary symptoms in the setting of both acute back injuries and chronic low back pain.…”