Sacral neuromodulation and pregnancy.
OBJECTIVE
Sacral neuromodulation is effective for lower urinary tract dysfunction. However, despite its increasing use and a preponderance of female patients treated to our knowledge its effect in pregnant women and developing fetuses remains unknown. Therefore, we obtained information on patients on sacral neuromodulation who then achieved pregnancy.


METHODS
Data were obtained using a standard questionnaire from 4 physicians with a total of 6 eligible patients. We recorded patient urological history, indication for neuromodulation, pregnancy course, the mode of delivery and neonatal health. We also noted the timing of implant deactivation and reactivation.


RESULTS
In 5 patients the stimulator was deactivated between weeks 3 and 9 of gestation, after which 2 with a history of urinary retention had urinary tract infection. In another case, stimulation was discontinued 2 weeks before conception. The only noted complication developed in a pregnancy in which birth was premature at 34 weeks. Three patients underwent normal vaginal delivery, including 1 in whom subsequent implant reactivation did not resolve voiding dysfunction. In 3 cases elective cesarean section was performed. All neonates were healthy.


CONCLUSIONS
When a patient on neuromodulation achieves pregnancy, the stimulation should be deactivated. If implant deactivation leads to urinary related complications that threaten the pregnancy, reactivation should be considered. Elective cesarean section should be discussed since it is possible for sacral lead damage or displacement to occur during vaginal delivery.
Wiseman
O J
OJ
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
v d  Hombergh
U
U
Koldewijn
E L
EL
Spinelli
M
M
Siegel
S W
SW
Fowler
C J
CJ
D000328:Adult; D004599:Electric Stimulation Therapy / Q000009:adverse effects*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008160:Lumbosacral Plexus / Q000502:physiology*; D011247:Pregnancy / Q000502:physiology*; D011256:Pregnancy Outcome; D014549:Urinary Incontinence / Q000628:therapy; D016055:Urinary Retention / Q000628:therapy*