title: Chronic pudendal nerve neuromodulation in women with idiopathic refractory detrusor overactivity incontinence: results of a pilot study with a novel minimally invasive implantable mini-stimulator.
abstract: OBJECTIVE
  To assess the results of chronic pudendal nerve neuromodulation with a novel technique in a pilot study on women with idiopathic refractory detrusor overactivity incontinence.
  
  
  METHODS
  A percutaneous screening test (PST) was performed in patients with urodynamically demonstrated detrusor overactivity incontinence. Such a test includes the performance of a cystometrogram without and with percutaneous pudendal nerve stimulation and is considered positive if stimulation results in a more than 50% increase in the bladder volume at the first involuntary detrusor contraction or the maximum cystometric capacity. Patients with a positive PST qualified for the implantation of a mini-neurostimulator with an integrated electrode, a so-called bion(R), adjacent to the pudendal nerve at Alcock's Canal. Five-day voiding-incontinence diaries were the main tool for the evaluation of therapy.
  
  
  RESULTS
  A PST was performed in 14 women. Six patients responded positively and received a bion. The degree of incontinence decreased significantly in this group, which also included patients in whom sacral neuromodulation had failed. There were no severe adverse events.
  
  
  CONCLUSIONS
  Chronic pudendal nerve stimulation may reduce the degree of detrusor overactivity incontinence, even in patients in whom sacral neuromodulation fails. Bion therapy is relatively simple and minimally invasive and is well tolerated by the patient.
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands. j.groen.1@erasmusmc.nl
authors.forename: Jan
authors.initials: J
authors.lastname: Groen
authors.forename: Christophe
authors.initials: C
authors.lastname: Amiel
authors.forename: J L H Ruud
authors.initials: JL
authors.lastname: Bosch
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009122:Muscle Hypertonia / Q000503:physiopathology / Q000628:therapy*; D009130:Muscle, Smooth / Q000294:innervation / Q000502:physiology; D010388:Pelvis / Q000294:innervation; D010865:Pilot Projects; D013686:Telemetry / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000503:physiopathology / Q000628:therapy*