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Reading Room


Activity Faculty

Andrew Sokol, MD
Georgetown University School of Medicine
Washington, DC


Article Summary

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;185:981-986.


Introduction

Sacral neuromodulation (SNM) is an FDA-approved treatment for refractory urgency incontinence, urinary frequency/urgency syndrome, and non-obstructive idiopathic urinary retention. Several studies show its efficacy at short and medium-term follow-up. This study retrospectively assesses the long-term outcomes, incidence, and causes of surgical re-intervention after SNM implantation for lower urinary tract dysfunction.


Methods

This retrospective study included 96 SNM device implants in 88 women and 8 men from 1994–2008 at a single institution.


Results

196 patients underwent PNE, and 49% of these underwent permanent SNM implant. PNE success rates by indication did not differ statistically (43.9% for IUR, 54.4% for UUI, 66% for BPS).


Expert Opinion

This paper is helpful in counseling patients about long-term outcomes with SNM. More specifically, it is helpful when counseling patients about the risks of revision and explanation and the most common reasons for both of these outcomes. The 39% risk of surgical re-intervention is consistent with long-term results in worldwide clinical trials.1,2

The generalizability of this study may be limited in that all surgeries were performed in a single center with a high degree of experience with SNM. Additionally, painful bladder syndrome was the reason for implant in 47.9% of patients in this study, and this is not an FDA approved indication for SNM in the United States.

However, this study does report the longest follow-up for SNM available in the literature, and supports its long-term success in patients with idiopathic urinary retention, urgency incontinence, and bladder pain syndrome. This paper reinforces the place of SNM in the armamentarium of physicians treating patients with lower urinary tract symptoms.


Additional References
  1. Siegel SW, Catanzaro F, Dijkema HE, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. 2000;56:87-91.
  2. 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;178:2029-34.

Article Link

http://www.ncbi.nlm.nih.gov/pubmed/21247597