FEMALE UROLOGY

Sacral neuromodulation: long-term experience of one center
Elhilali MM, Khaled SM, Kashiwabara T, Elzayat E, Corcos J
Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
Urology. 2005; 65: 1114-7

• Objectives: To perform a retrospective analysis of the long-term results of our experience with neuromodulation. Our center has been involved in the early studies leading to approval of the NeuroStim system of neuromodulation for the treatment of patients presenting with refractory lower urinary symptoms of urgency/frequency with or without incontinence and chronic urinary retention.
• Methods: A total of 52 patients have undergone implantation at our center since 1990 using very rigid criteria, including temporary percutaneous nerve evaluation for up to 7 days and a requirement of 50% improvement before consideration for implantation. Patients were followed up closely and a telephone questionnaire was conducted for those patients not seen in the previous 6 months. Of the 52 patients, 11 were not available for evaluation. Of the 41 remaining patients, 22 had urgency/frequency syndrome, 6 had urgency incontinence, 9 had urinary retention, and 4 had interstitial cystitis with intractable pelvic pain.
• Results: Of the 41 patients, 5 required explantation. These 5 patients were offered reimplantation but declined. Of the 22 patients in the urgency/frequency group, 10 (45%) had persistent improvement. In the urgency incontinence group, 3 of the 6 patients required explantation, and 1 (17%) reported improvement in the frequency of incontinence episodes. Of the 9 patients in the chronic urinary retention group, 7 (78%) had improvement.
• Conclusions: The long-term (up to 13 years) results of neuromodulation in patients presenting with urgency/frequency with and without urge incontinence and urinary retention were reviewed. The long-term results in the first two groups were not maintained over time. The patients with chronic urinary retention, although a small sample, fared better.
  
  
• Editorial Comment
  The authors report on the long-term results of patients treated with sacral neuromodulation for lower urinary tract voiding dysfunction. The authors noted that the greatest success of this therapeutic modality was in patients with chronic urinary retention. They had a less degree of efficacy in patients treated with urgency and frequency and minimal success in patients with urinary urge incontinence.
  This is an excellent paper reporting on the long-term results on sacral neuromodulation. It makes excellent reading for those physicians interested in the application of this technology in their practice. It highlights the efficacy of this therapy in the voiding dysfunction of urinary retention and the disappointing results when applied for pelvic pain or urinary urge incontinence. The discussion section is excellent especially in its efficient review of the literature available of the long-term results for chronic sacral neuromodulation. It is quite thought provoking that the technology had its highest success rates in a potentially idiopathic disease process.

Dr. Steven P. Petrou
Associate Professor of Urology
Mayo Medical School
Jacksonville, Florida, USA