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Reading Room


Activity Faculty

Patrick Culligan, MD, FACOG, FACS
Atlantic Health System
Morristown, New Jersey


Article Summary

van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007;178:2029-2034.


Introduction

Over the last 10–15 years, sacral neuromodulation has emerged as a viable treatment option for patients with refractory urinary frequency, urge incontinence and non-obstructive voiding dysfunction – largely because of the quality of the original clinical research studies. However, few long-term studies have been published.


Methods

Results

Expert Opinion

This study reflects the attitude expressed by many surgeons regarding sacral neuromodulation - namely that the technology should be used as a last resort (ie, in patients refractory to more conservative treatment approaches) due to the modest success rates (albeit within a very challenging group of patients) and significant risk of complications. The outcome measures used in this study are somewhat outdated in that they don’t directly reflect patients’ own assessment of success or failure.

The study includes an obvious selection bias that seems to cut both ways. Many of the patients who experienced poor results could have been lost to follow-up, yet many of the ones who completed the study did not have the benefit of newer/better iterations of the device.

Overall, sacral neuromodulation remains a very interesting treatment option, especially considering that there is still no general consensus as to the mechanism by which the technology actually works.


Article Link

http://www.ncbi.nlm.nih.gov/pubmed/17869298