Sacral nerve stimulation for voiding dysfunction: One institution's 11-year experience

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‐anchor...

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Bibliographic Details
Published in:Neurourology and urodynamics 2007-01, Vol.26 (1), p.19-28
Main Authors: Sutherland, Suzette E., Lavers, Ann, Carlson, Angeline, Holtz, Cindy, Kesha, Jyothi, Siegel, Steven W.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Electric Stimulation Therapy
Electrodes, Implanted
Female
Follow-Up Studies
Humans
Male
Middle Aged
overactive bladder (OAB)
pelvic floor dysfunction
Postoperative Complications
Prosthesis Implantation
Quality of Life
Retrospective Studies
sacral nerve stimulation
sacral neuromodulation
Sacrum - innervation
Severity of Illness Index
Surveys and Questionnaires
Treatment Outcome
Urinary Bladder, Overactive - surgery
Urinary Bladder, Overactive - therapy
voiding dysfunction
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Summary: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 ± 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 (±5.1) voids per 24 hr; 2.3 (±1.8) voids per night; 5.0 (±4.7) leaks per 24 hr; and 2.3 (±2.6) pads per 24 hr. Statistically significant 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 80%, and >90% in 69%, 50%, and 35% of patients, respectively. By quality of life survey, 60.5% of patients were satisfied and 16.1% were dissatisfied with current urinary symptoms. Only 13% (14 patients) abandoned therapy, making up a significant portion of those dissatisfied with current urinary symptoms. Good overall lead durability was seen (mean 22 months, range 1–121 months), with the first successful lead proving to be the most durable (mean 28 month
ISSN:0733-2467
1520-6777
DOI:10.1002/nau.20345