Sacral neuromodulation stands test of time in LUTD

Follow-up of patients at a Belgian institution reveals that sacral neuromodulation (SNM) is effective for the treatment of lower urinary tract dysfunction (LUTD) over the long term, but often requires reintervention.

Frank van der Aa and colleagues from University Hospitals Leuven retrospectively analyzed the outcomes of 217 patients (86% female) over a median of 46.9 months after SNM implant (Interstim, Medtronic, Minneapolis, Minnesota, USA). Overall, 30% were treated for urgency incontinence, 18% for urgency frequency syndrome, and 43% for idiopathic retention. The remaining patients had neurogenic LUTD due to multiple sclerosis or painful bladder syndrome/interstitial cystitis.

The overall success rate was 71%; defined as patients achieving at least 50% improvement in at least one voiding diary parameter for urgency incontinence and frequency syndrome and a 50% reduction in intermittent self-catheterisation in idiopathic retention.

Complete cure was reported in 20% of patients with urgency incontinence, 33% of those with urgency frequency syndrome, 63% with Fowler’s idiopathic retention, and 53% with non-Fowler’s idiopathic retention.

However, 41% of patients required surgical reintervention during follow-up, with a median of 1.7 and a maximum of 11 procedures required.

The main reasons for reintervention were device removal (26%), lead repositioning (32%), and battery depletion (15%). Overall, 20% of patients required a new device to be implanted during follow-up.

However, the team notes that there were significantly fewer interventions for lead repositioning in patients treated by the more recent percutaneous self-anchoring tined lead technique compared with those treated with the former open surgical technique (15 vs 42%), as well as a trend toward less need for device explantation and repositioning.

There was a low rate of postoperative complications with two cases of wound seroma and hematoma, respectively, at the wound site resolving spontaneously, and seven patients developing infections, four of which led to device removal.

“Although approved for approximately 15 years there are few studies assessing long term efficacy and adverse events when using this form of treatment for lower urinary tract dysfunction,” comment the authors.

Writing in BJU International, they say their results support the long-term use of the therapy and indicate that the evolution of the device and its usage will improve patient results.

“The introduction of newer techniques and more reliable screening will likely lead to better outcomes and less re-interventions in our opinion,” they conclude.

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