Elsevier

Urology

Volume 60, Issue 1, July 2002, Pages 52-56
Urology

Adult urology
Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction

https://doi.org/10.1016/S0090-4295(02)01630-8Get rights and content

Abstract

Objectives. To determine the long-term efficacy and complications of sacral nerve stimulation as an alternative therapy for pelvic floor dysfunction. Pelvic floor dysfunction is a complex problem that can be refractory to current treatment modalities. Conservative therapy rarely results in a durable cure of patients, and various surgical procedures have significant side effects and less than optimal results.

Methods. Sixty-four patients, 54 women and 10 men, with various forms of voiding dysfunction for whom other forms of therapy had failed underwent placement of the Medtronic Implantable Pulse Generator sacral nerve implant. The mean age was 47 years. The presenting complaint was frequency, urgency, and urge incontinence in 44 patients and chronic nonobstructive urinary retention requiring self-catheterization in 20 patients. Forty-one patients also had chronic pelvic and perineal pain associated with their voiding symptoms. The mean duration of symptoms was 69 months. All patients underwent percutaneous nerve evaluation before the permanent implant and demonstrated more than 50% improvement in their symptoms. All patients were evaluated at 1, 3, 6, 12, and 24 months, and yearly thereafter. The assessment of the voiding symptoms was done both subjectively by patient symptoms and objectively using voiding diaries recorded for 3 days. A validated verbal rating pain scale was used to evaluate pain levels.

Results. Eighty percent of the patients had 50% or greater improvement in their presenting symptoms and quality of life after the procedure, with a mean follow-up of 24 months. Patients with frequency-urgency showed a reduction in the number of voids per day with a significant increase in voided volumes. Patients with urge incontinence showed a reduction in leaking episodes from 6.4 to 2.0/24 hr, with a decrease in the number of pads used from 3.5 to 1.2/day. Sixteen of 20 patients with urinary retention were able to void with a residual volume of less than 100 mL. Patients with chronic pelvic pain showed a decrease in the severity of pain from a score of 5.8 to 3.7. Complications were minimal and encountered in 18.7% of the patients.

Conclusions. Sacral nerve stimulation is an effective and durable new approach to pelvic floor dysfunction with minimal complications. Test stimulation provides a valuable tool for patient selection.

Section snippets

Material and methods

Between October 1996 and January 2001, 64 patients (54 women and 10 men, mean age 47 years, range 22 to 76), with various forms of voiding dysfunction who were enrolled from three different medical centers, received a Medtronic Interstim Sacral Nerve Implant. The operations were performed at three different medical centers by three of us (S.A., S.C, S.F.). Forty-four patients presented with frequency, urgency, or urge incontinence. Twenty patients presented with idiopathic chronic urinary

Results

Eighty percent of the patients had 50% or greater improvement in their presenting symptoms and quality of life after the procedure, with a mean follow-up of 24 months (range 6 to 36). Patients were divided according to their presenting symptoms into three groups.

Group 1 consisted of patients who presented with frequency, urgency, and urge incontinence (n = 43 patients) (Fig. 1). Although 44 patients in this group underwent implantation, 1 patient was removed from the study because of a device

Comment

Pelvic floor dysfunction is a challenging problem that is frequently encountered in urologic practice. It affects a large number of patients who can present in a variety of ways. These include irritative voiding symptoms, such as frequency, urgency, and urge incontinence; difficulty in voiding with sense of incomplete emptying and a large postvoid residual volume, and actual retention. In addition, a large number of these patients will also complain of chronic pelvic and perineal pain and bowel

Conclusions

Sacral nerve stimulation is an effective treatment modality in patients with refractory pelvic floor dysfunction. It is safe and can be performed in a minimally invasive approach as an outpatient procedure. PNE test stimulation provides a valuable tool for properly selecting patients who would benefit the most from this type of therapy. Furthermore, studies of the indications for sacral nerve stimulation should be extended to involve other pelvic problems, including bowel and sexual

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    1

    S. R. Aboseif, S. Chalfin, and S. Freedman are proctors for Medtronic, Inc.

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