Elsevier

Urology

Volume 60, Issue 4, October 2002, Pages 598-602
Urology

Adult urology
Predictive factors for sacral neuromodulation in chronic lower urinary tract dysfunction

https://doi.org/10.1016/S0090-4295(02)01841-1Get rights and content

Abstract

Objectives

To investigate data from 211 patients who underwent a trial stimulation (percutaneous nerve evaluation [PNE]) to determine the clinical parameters that can enhance the prediction of PNE success. The advantageous effect of sacral neuromodulation depends on the accurate identification of suitable candidates during the preimplantation PNE.

Methods

A total of 211 patients (161 women and 50 men), with refractory urge incontinence, urgency-frequency syndrome, and urinary retention, underwent a PNE. Patient data (demographics, medical history, urologic investigations, and diagnosis) were collected. The PNE results were evaluated from a voiding diary and patient history. More than 50% improvement of voiding parameters was considered a successful PNE, and those patients were selected for implantation. Logistic regression analysis was performed. The factors tested for predicting the test result were sex, patient age, diagnosis, previous surgery, neurogenic bladder dysfunction, duration of complaints, and previous treatments.

Results

The PNEs were positive in 85 patients (40.3%) and negative in 105 patients (49.8%). In 18 patients (8.5%), the test electrode had migrated; 3 more patients were not assessable and were also excluded. Missing data on the variable “duration of complaints” reduced the number of patients in the analyses from 190 to 174 patients.

Conclusions

Intervertebral disk prolapse, duration of complaints, neurogenic bladder dysfunction, and urge incontinence were found to be significant predictive factors. However, a PNE remains necessary to evaluate a patient’s chance of implant success objectively.

Section snippets

Material and methods

The study population consisted of all patients who underwent a PNE between May 1988 and May 1999 at the University Hospital Maastricht. All patients with refractory urge incontinence, urgency-frequency syndrome, and urinary retention who underwent a PNE were included. Patients with other indications, such as pelvic pain syndrome, were excluded from this study. All patients underwent a comprehensive evaluation consisting of history taking, physical examination, and urodynamic investigation. To

Results

The data from 50 men (23.7%) and 161 women (76.3%) were reviewed. The mean patient age was 51.5 years (SD 10.5, range 25 to 79). The men (55.3 years, SD 10.1) were significantly older (Student’s t test, P = 0.003) than the women (50.3 years, SD 10.4). In total, 15 patients (7.0%) were diagnosed with urgency-frequency syndrome, 94 (43.7%) with motor urge incontinence, 13 (6.0%) with sensory urge incontinence, 41 (19.1%) with complete chronic urinary retention, and 48 (22.3%) with incomplete

Comment

Sacral neuromodulation is an effective therapy for patients with various voiding dysfunctions. However, until now, no single predictive factor has been found to predict which patients with voiding dysfunction will benefit from this therapy. Reports addressing this subject have shown no conclusive predictive factor, possibly because the patient numbers were too small to achieve statistical significance.8, 14, 15, 17

This analysis of the data from a larger group of patients found several

Conclusions

In this study, some indicators to predict PNE outcome were found. A higher chance of a positive PNE was present in patients who underwent IDP surgery and in patients with urge incontinence. A higher chance of a negative PNE was found with patients with neurogenic bladder dysfunction and in patients with a relatively long duration of lower urinary tract dysfunction. However, the PNE is still necessary to determine objectively whether patients can be successfully implanted.

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