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Kurt E, Kollenburg L, Joosten S, van Dongen R, Engels Y, Henssen D, Vissers K. Preoperative Counseling in Spinal Cord Stimulation: A Designated Driver in Implantable Pulse Generator-Related Inconveniences? Neuromodulation 2024:S1094-7159(24)00630-5. [PMID: 39001726 DOI: 10.1016/j.neurom.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Spinal cord stimulation (SCS) has been reported to cause substantial pain relief and improved quality of life (QoL) in patients with persistent spinal pain syndrome (PSPS). Despite implantable pulse generator (IPG)-related inconveniences such as pain, shame, and discomfort affecting QoL and patient satisfaction, these are often neglected. Hence, the current study aims to determine the associations between patient satisfaction, IPG-related inconveniences, and preoperative counseling in a homogeneous group of patients with PSPS receiving SCS with IPG implantation in the gluteal or abdominal area. MATERIALS AND METHODS Retrospective data on sample characteristics were gathered from the EPIC (electronic health record software) digital patient data base. Prospective data on patient satisfaction were obtained with a questionnaire that covered various topics such as shame, pain, disturbances in daily/intense activities, night rest and/or sleep, discomfort caused by clothing, and preoperative counseling. The exact location of the IPG and its scar were determined with photo analysis. Thereafter, the site of IPG placement was classified into separate quadrants within the gluteal and abdominal area. Patient satisfaction was defined as accepting the current location of the IPG without having the wish to undergo revision surgery. RESULTS In total, 81 participants (50.9 ± 10 years) were included in this analysis, with patient satisfaction observed in 61 patients (75.3%). Among satisfied patients, more extensive preoperative counseling concerning IPG pain and discomfort was reported compared with patients who were not satisfied (p < 0.001). When comparing the two groups, significant differences were found in shame (8/81, 9.9%), IPG site pain (21/81, 25.9%), disturbance of activities (42/81, 51.9%), and clothing-related discomfort (42/81, 51.9%). CONCLUSIONS On the basis of the current results, shared decision-making and comprehensive preoperative provision of information are recommended to optimize patient satisfaction regarding IPG pain, discomfort, and inconveniences. Although many patients experience these disadvantages despite successful SCS for pain related to PSPS, most of them accept this if they have received adequate preoperative information about expectations.
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Affiliation(s)
- Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Linda Kollenburg
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sisley Joosten
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert van Dongen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dylan Henssen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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García Baos J, Huete Marañés Á, Mingote Á, Mendiola de la Osa A, Herrero Trujillano M, Ágreda García C, Martínez Rodríguez SH, García Fernández J. A pain in the pocket: Prevalence of pocket pain in patients with implantation of neuromodulation systems: A retrospective study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00120-3. [PMID: 38972352 DOI: 10.1016/j.redare.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/05/2024] [Accepted: 02/27/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Implantable pulse generator (IPG) is a neurostimulation therapy mediated by electrodes and surgically implanted in a subcutaneous "pocket" used for the control of numerous pathologies. This study examines both the prevalence of pain associated with IPG implantation ("pain pocket syndrome") and its associated characteristics. MATERIALS AND METHODS 56 patients with an IPG were included in the study. A health questionnaire was conducted to determine the presence of pain associated with the pocket and its neuropathic characteristics, as well as associated aesthetic concerns, location, situations that accentuate or alleviate pain, medications used for baseline and pocket pain control and other factors associated. RESULTS Pain in the area of implantation of the IPG had a prevalence of 52.6% of patients (n = 27), in our sample, with a mean score on the visual analogic scale (VAS) of 4.9 points [3.9-5.8 points], with neuropathic characteristics in 53.3% (n = 16) of the patients with pain, with differences between the mean VAS score of the female (5.5 [4.3-5.8 points]) and males (3.5 points [2.1-4.9 points]) (p = 0.04). CONCLUSION Pocket pain is a condition with a higher prevalence than described in previous studies, being of a higher intensity in females, involving a moderate pain in the area of implantation of the neuromodulating therapy. This pain has neuropathic characteristics and could require a repositioning intervention. Hence, more studies in this field should be carried to detect and prevent this syndrome.
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Affiliation(s)
- J García Baos
- CEU San Pablo University, Faculty of Medicine, Madrid, Spain
| | - Á Huete Marañés
- CEU San Pablo University, Faculty of Medicine, Madrid, Spain
| | - Á Mingote
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Majadahonda Universitary Hospital, Majadahonda, Madrid, Spain; Autonomous University of Madrid, Faculty of Medicine, Madrid, Spain.
| | - A Mendiola de la Osa
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Majadahonda Universitary Hospital, Majadahonda, Madrid, Spain
| | - M Herrero Trujillano
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Majadahonda Universitary Hospital, Majadahonda, Madrid, Spain
| | - C Ágreda García
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Majadahonda Universitary Hospital, Majadahonda, Madrid, Spain
| | - S H Martínez Rodríguez
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Majadahonda Universitary Hospital, Majadahonda, Madrid, Spain; Autonomous University of Madrid, Faculty of Medicine, Madrid, Spain
| | - J García Fernández
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Majadahonda Universitary Hospital, Majadahonda, Madrid, Spain; Autonomous University of Madrid, Faculty of Medicine, Madrid, Spain
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Tilborghs S, De Wachter S. Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects. Expert Rev Med Devices 2022; 19:161-187. [DOI: 10.1080/17434440.2022.2032655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sam Tilborghs
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
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Gandhi S, Gajewski JB, Koziarz A, Almutairi S, Ali A, Cox A. Long-term outcomes of sacral neuromodulation for lower urinary tract dysfunction: A 23-year experience. Neurourol Urodyn 2020; 40:461-469. [PMID: 33232534 DOI: 10.1002/nau.24583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022]
Abstract
AIMS To evaluate the long-term outcomes of sacral neuromodulation (SNM), and patient characteristics that may predict long-term success or complications. METHODS A single-center retrospective cohort study was performed of all patients who underwent SNM testing and implantation. Outcome results, resolution of symptoms, and device removal were reported. Multivariable logistic regression was used to identify predictors of success. Cox proportional hazards model was used to identify predictors for device removal. RESULTS Four hundred and thrity four patients underwent SNM test phase of which 241 (median age 48.0 years, 91.7% [221/241] female) had device implantation and were followed up for median [range] time of 4.0 (3 months-20.5 years) years. Multivariable logistic regression showed that male gender (odds ratio: 0.314; 95% confidence interval: 0.164-0.601, p = .0005) was independently associated with decreased peripheral nerve evaluation success. At final follow-up for patients who originally had device implantation, median (interquartile range) percent of symptoms resolution of all patients was 60.0% (0%-90%) and 69.3% (167/241) had SNM successful outcomes. Cox proportional hazards model showed no difference for time to SNM device removal with respect to patient age, gender, or diagnosis. 69.3% (167/241) patients had at least 1 surgical re-intervention. The most common reason at first surgical re-intervention was lead change only (26.3%, 44/167). CONCLUSION SNM is a minimally invasive procedure with good long-term success rates. There is a high revision rate but overall, SNM has a good safety profile and excellent long-term outcomes.
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Affiliation(s)
- Shreyas Gandhi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alex Koziarz
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sulaiman Almutairi
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Abdullah Ali
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
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Choi H, Gaiha R, Moeschler SM, Bendel MA, McCormick ZL, Teramoto M, Rosenow JM, Kielb S, Avram MJ, Walega DR. Factors Associated With Implantable Pulse Generator Site Pain: A Multicenter Cross-Sectional Study. Neuromodulation 2020; 24:1351-1356. [PMID: 33222364 DOI: 10.1111/ner.13317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Implantable pulse generator (IPG) site pain following neuromodulation procedures is a recognized complication. The site of the IPG placement varies depending on the neuromodulation type and physician preference. The incidence of IPG site pain as a function of the site of IPG implantation has not been studied systematically. MATERIALS AND METHODS We performed a multicenter cross-sectional survey of the incidence, severity, and quality of IPG site pain, location of the IPG, the pain management needs, functional impairment, and cosmetic appearance related to the IPG placement. Contingency table analysis was conducted for categorical variables, and logistic regression analysis and linear regression model was used. RESULTS The survey response rate was 60.5% (n = 510). Overall, 31.0% of patients reported pain at the IPG site in the last 72 hours with 31.4% reporting moderate to severe pain and 7.6% reporting severe pain. Older age was inversely associated with IPG-related pain (OR = 0.97, 95% CI = 0.96-0.99, p = 0.001). IPG implantation site did not have a statistically significant interaction with IPG site pain (p > 0.05). The most important factor for IPG site-associated pain was having a spinal cord stimulator implanted as compared to a deep brain stimulator, or sacral nerve stimulator. Most subjects reported no functional impairment related to IPG site pain (91%), found the IPG site pain as expected (80%), and found IPG site cosmetic appearance as expected (96%). CONCLUSIONS The incidence of IPG site pain is an important complication of invasive neuromodulation. The anatomic location of the IPG placement does not appear to affect the incidence or severity of IPG site pain. However, the presence of a pre-implant chronic pain disorder does appear to affect the frequency and severity of IPG site pain.
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Affiliation(s)
- Heejung Choi
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rishi Gaiha
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Masaru Teramoto
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Avram
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David R Walega
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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YANG (杨振杰) ZJ, BU (步华磊) HL, XIAO (肖学伟) XW, DU (杜广中) GZ, ZHANG (张友忠) YZ. Clinical study on bladder function recovery of 360 cases after radical hysterectomy treated by acupuncture 针刺对360例子宫全切术后患者膀胱功能影响分析. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2020. [DOI: 10.1016/j.wjam.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chartier-Kastler E, Le Normand L, Ruffion A, Dargent F, Braguet R, Saussine C, Tanneau Y, Graziana JP, Ragni E, Rabut B, Rousseau T, Biardeau X, Gamé X, Pierrevelcin J, Brassart E, Fourmarier M, Stoica G, Berrogain N, Yaghi N, Pecoux F, Capon G, Ferchaud J, Peyrat L, Bryckaert PE, Karsenty G, Melotti A, Abouihia A, Keller DUJ, Cornu JN. Sacral Neuromodulation with the InterStim™ System for Intractable Lower Urinary Tract Dysfunctions (SOUNDS): Results of Clinical Effectiveness, Quality of Life, Patient-Reported Outcomes and Safety in a French Multicenter Observational Study. Eur Urol Focus 2020; 7:1430-1437. [DOI: 10.1016/j.euf.2020.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022]
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Ghamarian PP, Moskowitz D. Intraoperative Tips and Tricks for Successful Sacral Neuromodulation. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00522-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Manjunath A, Keeter MK, Koloms K, Kielb SJ. Abdominal Versus Standard Placement of the Sacral Nerve Stimulator Implantable Pulse Generator. Urology 2019; 127:49-52. [PMID: 30794909 DOI: 10.1016/j.urology.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine patient factors prompting anterior abdominal wall placement of the sacral nerve stimulator implantable pulse generator and investigate revision and infection rates for buttock (standard) and abdominal placement. METHODS We retrospectively reviewed records of consecutive sacral nerve stimulation procedures by a single surgeon from 2012 to 2017 at a single institution. RESULTS 75 patients underwent sacral nerve stimulation--60 with standard and 15 with abdominally placed implantable pulse generators. The mean age and body mass index of the standard group was higher than that of the abdominal group and the majority was female. A greater proportion of patients in the abdominal group had a neurological diagnosis and was wheelchair-dependent. Overall, a total of 20 patients underwent 38 revision surgeries. The indications for revision surgery were pain, loss of efficacy, or lead migration. The standard group accounted for more revisions than the abdominal group (34vs 4 cases, P = .048), with no revisions due to pain in the abdominal group. The infection rate (2% vs 13%, P = .10), average time from implantation to revision, and operative duration were not statistically different between groups. CONCLUSION In a subset of patients who were wheelchair-dependent or lacked gluteal fat, placement of the implantable pulse generator in the anterior abdominal wall resulted in no revisions due to pain. Operative duration and infection rates were similar between abdominal and standard placement. Abdominal placement with extended length leads could be considered as a primary or revision option in these select patients.
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Affiliation(s)
- Adarsh Manjunath
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Mary Kate Keeter
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Kimberly Koloms
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stephanie J Kielb
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
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Zhang P, Wang JY, Zhang Y, Liao L, Lv JW, Ling Q, Wei ZQ, Zhong T, Xu ZH, Wen W, Li JY, Luo DY. Results of Sacral Neuromodulation Therapy for Urinary Voiding Dysfunction: Five-Year Experience of a Retrospective, Multicenter Study in China. Neuromodulation 2019; 22:730-737. [PMID: 30609180 DOI: 10.1111/ner.12902] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/02/2018] [Accepted: 09/14/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE This five-year, retrospective, multicenter study evaluated the long-term safety and efficiency of sacral neuromodulation (SNM) in Chinese patients with urinary voiding dysfunction. PATIENTS AND METHODS This is a Chinese national, multicenter, retrospective study that included 247 patients (51.2% female) who received an implantable pulse generator (IPG) (InterStim, Medtronic, Minneapolis, MN, USA) between 2012 and 2016. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline. The results were further stratified by identifying patients who showed >50% improvement and those although showed <50% improvement but still wanted to receive IPG; these data were collected and analyzed for general improvement. RESULTS Following test stimulation, 187 patients (43%) declined implantation and 247 (57%) underwent implantation using InterStim®. Among 247 patients, 34 (13.7%) had overactive bladder (OAB), 59 (23.8%) had interstitial cystitis/bladder pain syndrome (IC/BPS), 47 (19%) had idiopathic urinary retention (IUR), and 107 (44.1%) had neurogenic bladder (NB). IPG efficiency rate for OAB, interstitial cystitis/bladder pain syndrome, idiopathic urinary retention, and neurogenic bladder were 42.5, 72.4, 51.6, and 58.8%, respectively. The mean duration of follow-up was 20.1 ± 12.8 months. CONCLUSIONS SNM appears effective in the long term, with a total IPG implantation rate of approximately 57% (ranging between 42.5 and 72.4% depending on indication). Interstitial cystitis/bladder pain syndrome appear to be the best indication for stage I testing. Chinese neurogenic bladder patients are most inclined to choose SNM. SNM is relatively safe, with low postoperation adverse events of 16.1% and reoperation rate of 3.2% during the follow-up period.
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Affiliation(s)
- Peng Zhang
- Department of Urology, Beijing Chaoyang Hospital, Institute of Urology, Capital Medical University, Beijing, P.R. China
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, P.R. China
| | - Jian-Wei Lv
- Department of Urology, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Zhong-Qing Wei
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Tie Zhong
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, P.R. China
| | - Zhi-Hui Xu
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou, P.R. China
| | - Wei Wen
- Department of urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Jia-Yi Li
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - De-Yi Luo
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
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Post-Implant Management of Sacral Neuromodulation. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Goldman HB, Lloyd JC, Noblett KL, Carey MP, Castaño Botero JC, Gajewski JB, Lehur PA, Hassouna MM, Matzel KE, Paquette IM, de Wachter S, Ehlert MJ, Chartier-Kastler E, Siegel SW. International Continence Society best practice statement for use of sacral neuromodulation. Neurourol Urodyn 2018; 37:1823-1848. [PMID: 29641846 DOI: 10.1002/nau.23515] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/04/2018] [Indexed: 12/31/2022]
Abstract
AIMS Sacral neuromodulation (SNM) is an accepted therapy for a variety of conditions. However, despite over 20 years of experience, it remains a specialized procedure with a number of subtleties. Here we present the recommendations issued from the International Continence Society (ICS) SNM Consensus Panel. METHODS Under the auspices of the ICS, eight urologists, three colorectal surgeons and two urogynecologists, covering a wide breadth of geographic and specialty interest representation, met in January 2017 to discuss best practices for neuromodulation. Suggestions for statements were submitted in advance and specific topics were assigned to committee members, who prepared and presented supporting data to the group, at which time each topic was discussed in depth. Best practice statements were formulated based on available data. This document was then circulated to multiple external reviewers after which final edits were made and approved by the group. RESULTS The present recommendations, based on the most relevant data available in the literature, as well as expert opinion, address a variety of specific and at times problematic issues associated with SNM. These include the use of SNM for a variety of underlying conditions, need for pre-procedural testing, use of staged versus single-stage procedures, screening for success during the trial phase, ideal anesthesia, device implantation, post-procedural management, trouble-shooting loss of device function, and future directions for research. CONCLUSIONS These guidelines undoubtedly constitute a reference document, which will help urologists, gynecologists, and colorectal surgeons optimize their use of SNM for refractory urinary urgency and frequency, UUI, NOR, and FI.
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Affiliation(s)
- Howard B Goldman
- Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jessica C Lloyd
- Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karen L Noblett
- Axonics Modulation Technologies and Department of Obstetrics and Gynecology, University of California-Irvine, Irvine, California
| | - Marcus P Carey
- Division of Urogynaecology, Frances Perry House, Parkville, Victoria, Australia
| | | | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul A Lehur
- Clinique de Chirurgie Digestive et Endocrinienne, Universite de Nantes, Nantes, France
| | - Magdy M Hassouna
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Klaus E Matzel
- Division of Coloproctology, University of Erlangen, Erlangen, Germany
| | - Ian M Paquette
- Department of Surgery, Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, University of Antwerpen, Belgium
| | | | - Emmanuel Chartier-Kastler
- Department of Urology, Academic Hospital Pitié-Salpétrière, Medical School Sorbonne Université, Paris, France ECK
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The effect of sacral neuromodulation on pregnancy: a systematic review. Int Urogynecol J 2017; 28:1357-1365. [PMID: 28160010 DOI: 10.1007/s00192-017-3272-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/08/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the effects of sacral neuromodulation (SNM) on pregnancy and the impact of delivery on SNM function. METHODS A systematic search was conducted through January 2016. We selected studies including women who had SNM and a subsequent pregnancy. RESULTS Out of 2,316, eight studies were included, comprising 22 patients (26 pregnancies). SNM indications were Fowler's syndrome in 11, urinary retention in 6, fecal incontinence in 1, fecal and urinary urgency in 1, overactive bladder in 1, intractable interstitial cystitis in 1, and myelodysplasia in 1. SNM stayed on in 8 pregnancies. In the remaining 18 pregnancies in which the device was deactivated, 7 had recurrent urinary tract infections, including 1 with pyelonephritis and 2 who requested reactivation owing to recurrent symptoms. Outcomes were reported in 25 pregnancies, 16 had Cesarean section (CS) and 9 had vaginal delivery, including 2 operative deliveries. Out of 25, two infants had pilonidal sinus and motor tic disorder (exhibited at the age of 2 years), both from the same mother. After delivery, SNM was functioning in 15 (60%), 4 required reprogramming, and 3 required replacement (1 had recurrence of fecal incontinence after her operative delivery with evidence of displaced leads and 1 patient reported decreased SNM effects after her two CS), and 3 decided to remove the device (2 out of 3 patients were free of symptoms after SNM deactivation and requested removal). CONCLUSION Within the current limited evidence, the decision regarding SNM activation or deactivation should be individualized. A registry for those patients is recommended.
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Sukhu T, Kennelly MJ, Kurpad R. Sacral neuromodulation in overactive bladder: a review and current perspectives. Res Rep Urol 2016; 8:193-199. [PMID: 27822462 PMCID: PMC5087764 DOI: 10.2147/rru.s89544] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Overactive bladder (OAB) symptoms of urgency, frequency, and urge incontinence currently affect a substantial portion of the population, especially as age increases. Sacral neuromodulation has become a popular option for refractory OAB symptoms over the past 2 decades. Studies have demonstrated that it is an effective treatment for OAB and urge incontinence as indicated by decreased number of voids, increased bladder capacity, and fewer leakage events. In addition, the effects have proved to be durable to multiple years following implantation. These benefits come at the expense of a high rate of adverse events, although with comparable long-term cost-effectiveness to botulinum toxin A. We aimed to review the literature that demonstrates that sacral neuromodulation continues to be an efficacious treatment for refractory OAB wet and dry patients, with continuously expanding indications.
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Affiliation(s)
- Troy Sukhu
- Department of Urology, University of North Carolina, Chapel Hill
| | | | - Raj Kurpad
- Department of Urology, University of North Carolina, Chapel Hill
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Liberman D, Ehlert MJ, Siegel SW. Optimizing Outcomes of Sacral Neuromodulation for the Treatment of Urinary Retention. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0373-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martellucci J. The technique of sacral nerve modulation. Colorectal Dis 2015; 17:O88-94. [PMID: 25605221 DOI: 10.1111/codi.12900] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/12/2014] [Indexed: 02/08/2023]
Abstract
AIM The aim of this review was to summarize current knowledge and recommendations regarding the technique of implantation of the electrode in performing sacroneuromodulation (SNM) and the available information on programming parameters and implantation algorithms. METHOD All English-language articles published from January 1985 to December 2013 that reported the SNM surgical technique and results were considered for inclusion. Data were considered useful for the present review only if related to: (i) peripheral nerve evaluation; (ii) temporary nerve stimulation; (iii) definitive impulse generator placement; and (iv) parameters programming. RESULTS The literature search revealed 193 potentially relevant studies from initial electronic search terms and eligibility criteria, and these studies were evaluated in detail. In total, 41 studies were included in the final analysis. Of the studies reviewed, the majority (n = 37) were prospective or retrospective case series. Only three randomized clinical trials were eligible for inclusion. CONCLUSION Although the technique seems to be standardized, several steps still need to be clarified in order to define the best way to perform the procedure and then to maximize the outcome.
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Affiliation(s)
- J Martellucci
- General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Firenze, Italy
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YAMANISHI T, KAGA K, FUSE M, SHIBATA C, UCHIYAMA T. Neuromodulation for the Treatment of Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2015; 7:121-32. [DOI: 10.1111/luts.12087] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/11/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Tomonori YAMANISHI
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
| | - Kanya KAGA
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
| | - Miki FUSE
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
| | - Chiharu SHIBATA
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
| | - Tomoyuki UCHIYAMA
- Department of Urology; Continence Center, Dokkyo Medical University; Tochgi Japan
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Abstract
Sacral nerve stimulation is a young but promising technique in the treatment of chronic voiding dysfunctions. Electrical stimulation of the S3 nerve--using a pacemaker device--is able to treat a wide range of pelvic floor dysfunctions. This article gives a brief review on the indications, mechanisms of action and possible complications of this technique. Furthermore, new evolutions in the domain of sacral nerve modulation are discussed.
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Affiliation(s)
- Frederick Peeren
- University Hospital Gent, Department of Urology, De Pintelaan 185, B-9000 Gent, Belgium.
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Osman NI, Chapple CR. Fowler's syndrome—a cause of unexplained urinary retention in young women? Nat Rev Urol 2013; 11:87-98. [DOI: 10.1038/nrurol.2013.277] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kantartzis KL, Shepherd JP. Cost-Effectiveness of Test Phase Implantation Strategies for InterStim® Sacral Neuromodulation. Female Pelvic Med Reconstr Surg 2013; 19:322-7. [DOI: 10.1097/spv.0b013e3182a5deb4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Skull A, Hull TL. Sacral nerve stimulation for fecal incontinence. Expert Rev Med Devices 2013; 9:477-82. [PMID: 23116074 DOI: 10.1586/erd.12.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fecal incontinence (FI), which can severely affect a person's quality of life, is a difficult problem to treat. For some patients, limited management options exist. Sacral nerve stimulation, also known as sacral neuromodulation, although long established for urinary incontinence, has gained acceptance in treating FI. One unique aspect is that the procedure is performed in two stages. During the first stage, a temporary lead is inserted into the S3 sacral foramen and the patient can monitor improvement before a permanent device is implanted. While this procedure has proven to be effective for treating FI, it is also attractive owing to the low morbidity and low infection risk reported in the literature.
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Affiliation(s)
- Angela Skull
- Colorectal Department, St Richard's Hospital, Spitalfield Land, Chichester, West Sussex, UK
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Falletto E, Ganio E, Naldini G, Ratto C, Altomare DF. Sacral neuromodulation for bowel dysfunction: a consensus statement from the Italian group. Tech Coloproctol 2013; 18:53-64. [PMID: 23564270 DOI: 10.1007/s10151-013-1002-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/07/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Representatives from the Italian centers experienced in sacral neuromodulation (SNM) for the treatment of bowel dysfunction met in order to define the current clinical practice in Italy and to produce a consensus statement regarding indications for this therapy and patient management. METHODS Fifty Italian colonproctologists were asked to complete a questionnaire concerning their clinical practice in SNM (290 questions, grouped within 4 broad areas). Physicians expressed their opinion by completing the questionnaire, assigning to each statement their level of agreement according to the 5-point Likert scale; the data were analyzed by attributing to each expert's answers a weight proportional to the degree of experience. During a meeting held 2 months later, the critical aspects of the therapy were re-examined and discussions held with the goal of reaching an agreement on controversial topics. The available literature was reviewed. RESULTS Patient selection criteria, etiology, diagnostic investigations, test procedures and implantation, follow-up and evaluation of results have been reviewed. The aim was to achieve an algorithm for patient management, showing the place of SNM in the treatment of bowel dysfunction. The approach in case of treatment failure was also discussed. CONCLUSIONS Analysis of the data collected reveals substantial consensus at the national level concerning all the main points with regard to the therapy. The recommendations expressed in this article can be considered as national guidelines and taken into account by the principal international implantation centers.
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Affiliation(s)
- E Falletto
- Department of Surgery, Città della Scienza e della Salute, San Giovanni Battista Hospital, Corso Bramante 88, Turin, Italy,
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Sacral neuromodulation and intravesical botulinum toxin for refractory overactive bladder. Curr Opin Obstet Gynecol 2012; 24:331-6. [DOI: 10.1097/gco.0b013e3283573ff9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Groen LA, Hoebeke P, Loret N, Van Praet C, Van Laecke E, Ann R, Vande Walle J, Everaert K. Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms: 15-year experience. J Urol 2012; 188:1313-7. [PMID: 22902022 DOI: 10.1016/j.juro.2012.06.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Sacral nerve modulation with an implantable pulse generator is not an established treatment in children. This therapy has been described for dysfunctional elimination syndrome and neurogenic bladder. We report 2 new indications for this approach in children, ie bladder overactivity and Fowler syndrome. The aim of this study was to improve the results of future treatment for sacral neuromodulation in children by describing factors favorable for good outcomes with this method. MATERIALS AND METHODS A total of 18 children 9 to 17 years old were studied. Mean ± SD followup was 28.8 ± 43.8 months. Of the patients 16 underwent S3 sacral neuromodulation and 7 underwent pudendal stimulation (5 as a revision, 2 from the beginning). RESULTS Initial full response was achieved in 9 of 18 patients (50%) and partial response in 5 (28%). In patients presenting with incontinence mean ± SD number of incontinence episodes weekly improved significantly from 23.2 ± 12.4 to 1.3 ± 2.63 (p <0.05). In patients requiring clean intermittent catheterization there was a significant decrease in mean ± SD daily frequency of catheterization from 5.2 ± 1.6 to 2.0 ± 1.9 (p <0.05). At the end of the study 6 of 15 patients (40%) had a full response and 5 (33%) had a partial response, while 4 implantable pulse generator devices (27%) were explanted because of failure. CONCLUSIONS Sacral neuromodulation is feasible in the pediatric population, with good short-term (78% full or partial response) and satisfactory long-term results (73%). Sacral neuromodulation can offer good results for overactive bladder, dysfunctional elimination syndrome and Fowler syndrome. Pudendal nerve stimulation is a feasible salvage treatment that can be useful in cases when S3 implantation is impossible or unsuccessful.
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Affiliation(s)
- Luitzen-Albert Groen
- Pediatric Urologic Nephrologic Center, Ghent University Hospital, Ghent, Belgium.
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Murphy AM, Krlin RM, Vasavada SP. An Update on Neuromodulation for Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Postoperative issues of sacral nerve stimulation for fecal incontinence and constipation: a systematic literature review and treatment guideline. Dis Colon Rectum 2011; 54:1443-60. [PMID: 21979192 DOI: 10.1097/dcr.0b013e318227f65d] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is a lack of knowledge on the incidence and management of suboptimal therapeutic effect and the complications associated with sacral nerve stimulation for fecal incontinence and constipation. OBJECTIVE This study aimed to review current literature on postoperative issues and to propose a treatment algorithm. DATA SOURCE PubMed, MEDLINE, and EMBASE were searched using the keywords "sacral nerve stimulation," "sacral neuromodulation," "fecal incontinence," and "constipation" for English-language articles published from January 1980 to August 2010. A further search was conducted on a wider literature using the keywords "complication," "adverse effect," "treatment failure," "equipment failure," "infection," "foreign-body migration," "reoperation," "pain," and "algorithm." STUDY SELECTION Four hundred sixty-one titles were identified, and after a title and abstract review, 135 were subjected to full article review; 89 were finally included in this review. Five articles were added by manual search and consensus. RESULTS Forty-eight studies were identified as cohort studies reporting on postoperative issues, including 1661 patients who underwent percutaneous nerve evaluation and 1600 patients who proceeded to sacral nerve stimulation therapy. Pooled data showed that the most common problem during percutaneous nerve evaluation was lead displacement (5.3%). The incidence of suboptimal outcome, pain, and infection after implantation was 12.1%, 13.0%, and 3.9%. LIMITATIONS There was significant underreporting of untoward events, because 60% of the studies did not report complications during percutaneous nerve evaluation, and suboptimal outcome after implantation was not disclosed in 44% of the studies. CONCLUSIONS The incidence of untoward events associated with sacral nerve stimulation appears to be low. However, there is a significant underreporting of the incidence. Using the information from the structured and systematic literature review, we formulated a clinically relevant guideline for reporting and managing postoperative issues. The guideline can provide a framework for clinical practice.
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Amend B, Khalil M, Kessler TM, Sievert KD. How Does Sacral Modulation Work Best? Placement and Programming Techniques to Maximize Efficacy. Curr Urol Rep 2011; 12:327-35. [DOI: 10.1007/s11934-011-0204-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Pelvic electrical neuromodulation for the treatment of overactive bladder symptoms. Adv Urol 2011; 2011:757454. [PMID: 21687571 PMCID: PMC3113365 DOI: 10.1155/2011/757454] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 03/13/2011] [Indexed: 12/15/2022] Open
Abstract
Overactive bladder syndrome negatively affects the daily life of many people. First-line conservative treatments, such as antimuscarinics, do not always lead to sufficient improvement of the complaints and/or are often associated with disabling adverse effects leading to treatment failure. Electrical stimulation of the sacral nerves has emerged as an alternative and attractive treatment for refractory cases of bladder overactivity. Few theories attempted to explain its mechanism of action which remains elusive. It involves percutaneous posterior tibial nerve stimulation and more commonly sacral neuromodulation. For the latter, temporary sacral nerve stimulation is the first step. If the test stimulation is successful, a permanent device is implanted. The procedure is safe and reversible. It carries a durable success rate. The technique should be combined with careful followup and attentive adjustments of the stimulation parameters in order to optimize the clinical outcomes. This paper provides a review on the indications, possible mechanisms of action, surgical aspects and possible complications, and safety issues of this technique. The efficacy of the technique is also addressed.
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Abstract
The remit of this article is to provide an overview of urinary retention in women, taking into account the predisposing factors, aetiology, investigations and treatments. The information presented is based on a widespread search of the English literature using multiple library sites on the internet and on personal experience. Urinary retention occurs when there is impaired bladder emptying, resulting in a high post-void urinary residual. It is often associated with restricted voiding. The aetiology is manifold and thus the symptomatic patient may present to the urologist, gynaecologist, neurologist or physician. Once the problem is identified, and predisposing factors excluded (e.g. opiates), the patient has to be investigated fully. In the Department of Uro-Neurology at the National Hospital for Neurology and Neurosurgery in the UK, we advocate the use of urethral sphincter assessments, including urethral pressure studies, ultrasound volume assessment and electromyography. This article will take a detailed look at all aspects of assessing these patients. In those in whom diagnosis is reached, sacral neuromodulation (SNM) is the treatment of choice. As a modality, SNM has its supporters but also its detractors. Thus, it is essential that all patients are fully counselled before undergoing this surgery. Urinary retention in women is still poorly understood. This article serves to demystify the issues raised in having this condition, by looking closely at the currently known science. It is clear that some patients may be diagnosed with Fowler's syndrome and may thus be more treatable by SNM than others, but this still leaves a significant proportion of patients with no diagnosis and no satisfactory therapy. A great deal of work still needs to be done on the understanding of the pathogenesis, the provision of more distinct investigations and the development of better treatment modalities.
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Ghazwani YQ, Elkelini MS, Hassouna M. Association Between Stimulation Parameters and Loss of Efficacy of Selective Sacral Nerve Root Stimulation. Neuromodulation 2011; 14:266-70. [DOI: 10.1111/j.1525-1403.2011.00330.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hetzer FH. Fifteen years of sacral nerve stimulation: from an open procedure to a minimally invasive technique. Colorectal Dis 2011; 13 Suppl 2:1-4. [PMID: 21284794 DOI: 10.1111/j.1463-1318.2010.02517.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM This historical review describes the development of InterStim™ therapy from an open procedure to a minimally invasive technique for the treatment of pelvic floor disorders. The latest technological and surgical evaluations of sacral nerve stimulation (SNS) are presented with their impact on the therapy's success and safety. METHOD A search for relevant literature on SNS in the PubMed database was carried out for this review, which focuses on technical modifications and related clinical outcomes. RESULTS InterStim™ therapy for faecal incontinence was introduced in Europe in 1995. Since its introduction, technical improvements in devices and leads have progressed SNS from an open one-stage procedure to a minimally invasive two-stage technique. A smaller neurostimulator and particularly the new tined lead allow InterStim™ therapy to be performed under local anaesthesia and in an outpatient setting. Additionally, the use of the self-anchoring tined lead has reduced the number of technical failures and improved the test phase significantly, from 60% to 80%. The new smaller-in-size neurostimulator facilitates the implant procedure and further improves patient comfort. CONCLUSION By using new technical achievements over the past 15 years, InterStim™ therapy has become a highly effective and safe procedure for selected patients with faecal incontinence.
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Affiliation(s)
- F H Hetzer
- Department of Surgery, Cantonal Hospital, Schaffhausen, Switzerland.
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Al-zahrani AA, Elzayat EA, Gajewski JB. Long-term outcome and surgical interventions after sacral neuromodulation implant for lower urinary tract symptoms: 14-year experience at 1 center. J Urol 2011; 185:981-6. [PMID: 21247597 DOI: 10.1016/j.juro.2010.10.054] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Indexed: 01/23/2023]
Abstract
PURPOSE Few reports address the reoperation rate after sacral neuromodulation implants. We report our long-term results and reoperations during our 14-year experience with sacral neuromodulation at our center. MATERIALS AND METHODS We retrospectively reviewed the patient database at our center to assess the long-term outcome, incidence and cause of surgical re-intervention after InterStim® sacral neuromodulation implantation for lower urinary tract dysfunction between 1994 and 2008. RESULTS A total of 96 sacral neuromodulation devices were implanted in 88 women and 8 men. Indications for implantation were bladder pain syndrome in 47.9% of cases, urgency urinary incontinence in 35.4% and idiopathic urinary retention in 16.7%. The explantation rate was 20.8% and median time to removal was 18.5 months. Reasons for explantation in all subgroups were poor result in 12 patients, painful stimulation in 6 and radiation of stimulation to the leg in 2. Median long-term followup was 50.7 months. The long-term success rate was 87.5%, 84.8% and 73% in patients with idiopathic urinary retention, urgency urinary incontinence and bladder pain syndrome, respectively. Overall 39% of patients needed revision of the sacral neuromodulation implant. The main reason for revision was loss of stimulation in 58.5% of cases. The revision rate decreased with the introduction of the tined lead technique from 50% using lead Model 3092 to 31% using lead Model 3893 (Medtronic, Minneapolis, Minnesota). The battery was changed in 8 patients. Mean battery life was 101.8 months. CONCLUSIONS Sacral neuromodulation is a minimally invasive procedure with a good long-term outcome. The reoperation rate has improved with advances in surgical technique and equipment.
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Affiliation(s)
- Ali A Al-zahrani
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
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Marcelissen TA, Leong RK, de Bie RA, van Kerrebroeck PE, de Wachter SG. Long-Term Results of Sacral Neuromodulation With the Tined Lead Procedure. J Urol 2010; 184:1997-2000. [DOI: 10.1016/j.juro.2010.06.142] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Tom A.T. Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Randall K. Leong
- Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Rob A. de Bie
- Department of Epidemiology, Methodology and Statistics, University of Maastricht, Maastricht, the Netherlands
| | | | - Stefan G.G. de Wachter
- Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Bosch JR. An update on sacral neuromodulation: where do we stand with this in the management of lower urinary tract dysfunction in 2010? BJU Int 2010; 106:1432-42. [DOI: 10.1111/j.1464-410x.2010.09702.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gajewski JB, Al-Zahrani AA. The long-term efficacy of sacral neuromodulation in the management of intractable cases of bladder pain syndrome: 14 years of experience in one centre. BJU Int 2010; 107:1258-64. [DOI: 10.1111/j.1464-410x.2010.09697.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Herbison GP, Arnold EP. Sacral neuromodulation with implanted devices for urinary storage and voiding dysfunction in adults. Cochrane Database Syst Rev 2009:CD004202. [PMID: 19370596 DOI: 10.1002/14651858.cd004202.pub2] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The neural control of storage and voiding of urine is complex and dysfunction can be difficult to treat. One treatment for people with refractory symptoms is continuous electrical nerve stimulation of the sacral nerve roots using implanted electrodes and an implanted pulse generator. OBJECTIVES To determine the effects of implantable electrical stimulation devices in the treatment of urine storage and voiding problems. SEARCH STRATEGY We searched the Cochrane Incontinence Group Specialised Register (searched 10 February 2009), CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE (January 1980 to March 2008), EMBASE (January 1980 to March 2008), CINAHL (January 1982 to March 2008) and the reference lists of relevant articles. SELECTION CRITERIA Trials that tested implanted electronic stimulators connected to electrodes attached to the nerves and providing continuous electrical stimulation for neuromodulation. DATA COLLECTION AND ANALYSIS Both authors selected studies, assessed quality, and extracted data. MAIN RESULTS Eight reports of randomised studies that evaluated implants which provided continuous stimulation were included. It was unclear whether some reports included patients who also appeared in other reports, so no data were pooled. In spite of this, it seems clear that continuous stimulation offers benefits for carefully selected people with overactive bladder syndrome and for those with urinary retention but no structural obstruction.Many of the implants did not work and many required revision operations. Many questions remain about patient selection and the best way to use these devices. AUTHORS' CONCLUSIONS In spite of methodological problems, it would appear that some people benefit from implants which provide continuous nerve stimulation. More research is needed on the best way to improve patient selection, carry out the implant, and to find why so many fail. The effectiveness of implants should be tested against other interventions, particularly in people with an overactive bladder.
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Affiliation(s)
- G Peter Herbison
- Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand, 9054.
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Lombardi G, Del Popolo G. Clinical outcome of sacral neuromodulation in incomplete spinal cord injured patients suffering from neurogenic lower urinary tract symptoms. Spinal Cord 2009; 47:486-91. [DOI: 10.1038/sc.2008.172] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kaufmann S, Naumann CM, Hamann MF, Seif C, Braun PM, Jünemann KP, van der Horst C. Unilateral vs bilateral sacral neuromodulation in pigs with formalin-induced detrusor hyperactivity. BJU Int 2009; 103:260-3. [DOI: 10.1111/j.1464-410x.2008.07936.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE Sacral nerve stimulation is a safe and effective procedure for fecal incontinence. We investigated whether its efficacy is maintained long term. PATIENTS AND METHODS Sixty patients with fecal incontinence underwent permanent sacral nerve stimulation. Patients' data were prospectively recorded in the national registry of the Italian Group of sacral nerve stimulation. The severity of fecal incontinence was evaluated by the Wexner score, and data were collected in a bowel function diary. Quality of life was evaluated by the Italian version of the Medical Outcomes Survey Short Form (SF-36) questionnaire. RESULTS Fifty-two patients were available for long-term follow-up lasting at least 5 years. Compared with baseline, the Wexner score decreased significantly after definitive implantation (from 15 +/- 4 to 5 +/- 5, P < 0.001). At least 50 percent improvement in continence was achieved in 74 percent of the patients, and at least 70 percent improvement (median value) was achieved in 50 percent. The mean number of solid/liquid incontinence episodes decreased significantly from 0.5 (+/-0.5) to 0.1 (+/-0.3) per day (P = 0.004). Quality of life improved in all domains. The overall mean improvement in SF-36 scores was 39.8 percent. Both mean resting and squeeze anal pressures increased significantly, and maximum volume tolerated decreased significantly. CONCLUSIONS Sacral nerve stimulation maintains its efficacy long term, not only in regard to control of symptoms but also regarding quality of life.
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Spinelli M, Sievert KD. Latest Technologic and Surgical Developments in Using InterStim™ Therapy for Sacral Neuromodulation: Impact on Treatment Success and Safety. Eur Urol 2008; 54:1287-96. [DOI: 10.1016/j.eururo.2008.01.076] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
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Kessler TM, Fowler CJ. Sacral neuromodulation for urinary retention. ACTA ACUST UNITED AC 2008; 5:657-66. [DOI: 10.1038/ncpuro1251] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 10/13/2008] [Indexed: 11/09/2022]
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Abstract
Neuromodulation has been reported to be effective for the treatment of stress and urgency urinary incontinence. The cure and improvement rates of pelvic floor neuromodulation in urinary incontinence are 30-50% and 60-90%, respectively. In clinical practice, vaginal, anal and surface electrodes are used for external, short-term stimulation, and sacral nerve stimulation for internal, chronic (long-term) stimulation. The effectiveness of neuromodulation has been verified in a randomized, placebo-controlled study. However, the superiority to other conservative treatments, such as pelvic floor muscle training has not been confirmed. A long-term effect has also been reported. In conclusion, pelvic floor exercise with adjunctive neuromodulation is the mainstay of conservative management for the treatment of stress incontinence. For urgency and mixed stress plus urgency incontinence, neuromodulation may therefore be the treatment of choice as an alternative to drug therapy.
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Affiliation(s)
- Tomonori Yamanishi
- Department of Urology, Dokkyo University School of Medicine, Tochigi, Japan.
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Abstract
Voiding dysfunction, which includes incontinence, retention, and chronic pelvic pain, is a relatively frequent problem that can be difficult to manage. Neuromodulation via stimulation of the sacral nerves has been shown to improve these symptoms, although the exact mechanisms remain elusive. Techniques for nerve stimulation may vary, depending on the disease, location of pain, and the patient's anatomy. In addition to placement of electrodes on the sacral nerve roots, modulation has also been reported by peripheral branches of the sacral nerves including the pudendal and posterior tibial nerves. Newer surgical techniques have significantly decreased the morbidity of the procedures and increased the probability of a successful outcome.
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Affiliation(s)
- Robert D Mayer
- Department of Urology, University of Rochester, Rochester, New York 14642, USA.
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Chartier-Kastler E. Sacral neuromodulation for treating the symptoms of overactive bladder syndrome and non-obstructive urinary retention: >10 years of clinical experience. BJU Int 2007; 101:417-23. [DOI: 10.1111/j.1464-410x.2007.07233.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Datta SN, Chaliha C, Singh A, Gonzales G, Mishra VC, Kavia RBC, Kitchen N, Fowler CJ, Elneil S. Sacral neurostimulation for urinary retention: 10-year experience from one UK centre. BJU Int 2007; 101:192-6. [PMID: 17970787 DOI: 10.1111/j.1464-410x.2007.07282.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report our 10-year experience of sacral neurostimulation (SNS) for women in urinary retention, comparing the original one-stage with the newer two-stage technique, as SNS therapy is a well-established treatment for urinary retention secondary to urethral sphincter overactivity (Fowler's syndrome). PATIENTS AND METHODS Between 1996 and 2006, 60 patients with urinary retention had a SNS device inserted; their case records were reviewed and data on efficacy, follow-up, need for continued clean intermittent self-catheterization (CISC), complications and operative revision rate were assessed. RESULTS Overall, 43 of 60 (72%) women were voiding spontaneously, with a mean postvoid residual volume of 100 mL; 30 (50%) no longer needed to use CISC. During a total of 2878 months of SNS experience, adverse event episodes included lead migration in 20, 'box-site' pain in 19, leg pain/numbness in 18 and loss of response/failure in 18 patients; 53% of the women required a surgical revision related to their implanted stimulator. The efficacy of the two-stage was similar to that of the one-stage procedure (73% vs 70%). Women with a normal urethral sphincter electromyogram had worse outcomes than women with an abnormal test (43% vs 76%). Although the efficacy was no different in those taking analgesia/antidepressant medication, this group of women had a higher surgical revision rate. Failure and complications for the one-stage procedure were not restricted to the early follow-up period. The mean battery life of the implant was 7.31 years. CONCLUSIONS SNS has sustained long-term efficacy but the procedure has a significant complication rate. At present, the two-stage technique has comparable efficacy to the one-stage technique but a longer-term follow-up is required. The National Institute of Clinical Excellence recommended the use of SNS in women with urinary incontinence who fail to respond adequately to anticholinergic therapy, but patients choosing this treatment should be made aware of the high complication rate associated with the procedure.
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Affiliation(s)
- Soumendra N Datta
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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Sievert KD, Nagele U, Pannek J, Engeler D, Kuczyk M, Stenzl A. Subcutaneous tunneling of the temporary testing electrode significantly improves the success rate of subchronic sacral nerve modulation (SNM). World J Urol 2007; 25:607-12. [PMID: 17912530 DOI: 10.1007/s00345-007-0204-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 07/09/2007] [Indexed: 12/01/2022] Open
Abstract
Sacral nerve modulation (SNM) is an effective way to treat non-neurogenic dysfunctions of pelvic organs. For over 20 years, this technique has been used for the treatment of overactive bladder, urinary retention, pelvic pain and even more recently, fecal incontinence and constipation. The objective of the study is to improve the fixation of the temporary testing electrode (TTE) in order to obtain more reliable results in the testing phase which should lead to have a comparable success rate as the two-stage implant for a chronic implant. Twenty-eight patients (ratio of sex women:men = 3:1; with overactive bladder, urinary retention, pelvic pain syndrome and fecal incontinence) were evaluated by the modified temporary test electrode (TTE) placement. With the subcutaneous tunneling technique (mean time of evaluation 8.3 days), it is possible to perform percutaneous nerve evaluation (PNE) more effectively with an objective, reliable and less expensive outcome prior to the implantation of the implantable sacral nerve stimulator in almost 80% of the evaluated patients. Because the costs of therapy are not covered by health insurance in all countries, there is a need for an effective and inexpensive way to test and select patients appropriately. The tunneled TTE maintains its place for consistent amplitude during the entire test duration. The modification of placing the TTE produces repayable results. This technique can be performed on an outpatient basis to evaluate sacral nerve modulation as an early treatment option for non-dysfunctions of pelvic organs before they are forwarded to a specialized center for a chronic SNM implantation.
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Affiliation(s)
- Karl-Dietrich Sievert
- Department of Urology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
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van Kerrebroeck PEV, van Voskuilen AC, Heesakkers JPFA, Lycklama á Nijholt AAB, Siegel S, Jonas U, Fowler CJ, Fall M, Gajewski JB, Hassouna MM, Cappellano F, Elhilali MM, Milam DF, Das AK, Dijkema HE, van den Hombergh U. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol 2007; 178:2029-34. [PMID: 17869298 DOI: 10.1016/j.juro.2007.07.032] [Citation(s) in RCA: 348] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE This 5-year, prospective, multicenter trial evaluated the long-term safety and efficacy of sacral neuromodulation in patients with refractory urge incontinence, urgency frequency and retention. MATERIALS AND METHODS A total of 17 centers worldwide enrolled 163 patients (87% female). Following test stimulation 11 patients declined implantation and 152 underwent implantation using InterStim. Of those treated with implantation 96 (63.2%) had urge incontinence, 25 (16.4%) had urgency frequency and 31 (20.4%) had retention. Voiding diaries were collected annually for 5 years. Clinical success was defined as 50% or greater improvement from baseline in primary voiding diary variable(s). RESULTS Data for all implanted cases were reported. For patients with urge incontinence mean leaking episodes per day decreased from 9.6 +/- 6.0 to 3.9 +/- 4.0 at 5 years. For patients with urgency frequency mean voids per day decreased from 19.3 +/- 7.0 to 14.8 +/- 7.6, and mean volume voided per void increased from 92.3 +/- 52.8 to 165.2 +/- 147.7 ml. For patients with retention the mean volume per catheterization decreased from 379.9 +/- 183.8 to 109.2 +/- 184.3 ml, and the mean number of catheterizations decreased from 5.3 +/- 2.8 to 1.9 +/- 2.8. All changes were statistically significant (p <0.001). No life threatening or irreversible adverse events occurred. In 102 patients 279 device or therapy related adverse events were observed. At 5 years after implantation 68% of patients with urge incontinence, 56% with urgency frequency and 71% with retention had successful outcomes. CONCLUSIONS This long-term study demonstrates that InterStim therapy is safe and effective for restoring voiding in appropriately selected cases refractory to other forms of treatment.
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