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Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation

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Abstract

Refractory overactive bladder (OAB) after urethrolysis for iatrogenic bladder outlet obstruction (BOO) is a clinical dilemma without established guidelines for management. We sought to evaluate the efficacy of sacral neuromodulation (SNM) in the management of this complex patient population. Retrospective review identified eight patients who underwent SNM secondary to refractory OAB after urethrolysis or sling take-down. SNM was performed with the Interstim® device (Medtronic, Minneapolis) using a two-stage implant technique. SNM outcomes were determined subjectively during follow-up. Validated questionnaires were completed to assess symptom bother, patient satisfaction, and quality of life. Statistical analyses were conducted using Stata® version 9.0. Six patients had a favorable response to SNM during test stimulation and underwent implantation of the implantable pulse generator (IPG). With follow-up of 15.7 ± 11.1 months (6–34), all patients significantly improved, with three patients being dry and three patients having one to two urgency incontinence episodes per week. Patient-reported outcomes indicated that patients perceived themselves as very much improved (3) or much improved (3) after SNM, while those failing test stimulation perceived no change. Quality of life and symptom bother were significantly better in SNM responders vs nonresponders. SNM appears to be an effective and viable treatment option in this complex patient population. Further work is needed to determine clinical factors predictive of outcome and durability of response.

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Abbreviations

AUASI:

American Urological Association Symptom Index

BOO:

bladder outlet obstruction

CIC:

clean intermittent catheterization

IPG:

implantable pulse generator

LUTS:

lower urinary tract symptoms

OAB:

overactive bladder

OAB-q:

overactive bladder questionnaire

PGI-I:

Patient Global Impression of Improvement

PGI-S:

Patient Global Impression of Severity

PVR:

postvoid residual

PVS:

pubovaginal sling

QOL:

quality of life

SNM:

sacral neuromodulation

SUI:

stress urinary incontinence

UDS:

urodynamics

UUI:

urinary urgency incontinence

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Author information

Authors and Affiliations

  1. Clinical Instructor, Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 MCN, Nashville, TN, 37232-2765, USA

    Jonathan S. Starkman, John W. Duffy III, Christopher E. Wolter, Melissa R. Kaufman, Harriette M. Scarpero & Roger R. Dmochowski

Authors
  1. Jonathan S. Starkman
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  2. John W. Duffy III
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  3. Christopher E. Wolter
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  4. Melissa R. Kaufman
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  5. Harriette M. Scarpero
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  6. Roger R. Dmochowski
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Corresponding author

Correspondence to Jonathan S. Starkman.

Appendix

Appendix

A.1. Patient Global Impression of Improvement (PGI-I)

Check the one response that best describes how your urinary condition is now, compared with how it was before your operation:

  1. 1.

    Very much better

  2. 2.

    Much better

  3. 3.

    A little better

  4. 4.

    No change

  5. 5.

    A little worse

  6. 6.

    Much worse

  7. 6.

    Very much worse

A.2. Patient Global Impression of Severity (PGI-S)

Check the one response that best describes how your urinary condition is now:

  1. 1.

    Normal

  2. 2.

    Mild

  3. 3.

    Moderate

  4. 4.

    Severe

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Starkman, J.S., Duffy, J.W., Wolter, C.E. et al. Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation. Int Urogynecol J 19, 277–282 (2008). https://doi.org/10.1007/s00192-007-0433-6

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  • DOI: https://doi.org/10.1007/s00192-007-0433-6

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