[Cystomanometric study of bladder sensation during sacral neuromodulation test].
OBJECTIVE
Prospective clinical and urodynamic study evaluating modification of bladder sensation during sacral neuromodulation (SNM).


METHODS
24 consecutive patients with non-neurological hyperactive bladder underwent an SNM test. Questioned about their symptoms before and during the test by the urinary handicap assessment scale, patients were divided into two groups: A (improved) and B (not improved). Group A consisted of patients obtaining 50% improvement of their symptoms with SNM followed by return of symptoms at the end of the test, while the other patients constituted group B. We then compared the cystomanometric results according to their clinical response.


RESULTS
The mean age was 53 years: 10 patients with a good response constituted group A (n=10, i.e. 42%) and 14 patients with a poor response constituted group B (n=14, i.e. 58%). Clinically, in patients with a good response, SNM decreased urge incontinence by 100%, day-time frequency by 89% and protections by 55%. Urodynamic assessment in group A during the test demonstrated a significant increase of +23% of bladder capacity (p<0.01), +57% of the volume of onset of the first unstable contraction (p<0.004), +83% of bladder volume to the first urge to urinate BI (p<0.001) and +46% to urgency B3 (p<0.04). During SNM, cystometry revealed that 1 or 2 bladder filling volumes were increased at B1 and/or B3 in 100% of improved subjects. In contrast, 1 or 2 volumes decreased at B1 and/or B3 in 58% of non-improved subjects. No significant difference of intensity of unstable contractions was observed between the 2 groups during SNM (p=0.31).


CONCLUSIONS
A significant correlation was observed between the two methods of clinical and urodynamic assessment. Our results suggest the use of the cystomanometric increase of bladder volume at B1 and B3 as selection criterion for candidates for SNM with non-neurological hyperactive bladder.
Service d'Urologie, Hôpitaux de Brabois, Vandoeuvre les Nancy, France.
François
F
Leclers
Eric
E
Mourey
Jean Marie
JM
Galas
Luc
L
Cormier
Philippe
P
Mangin
D000368:Aged; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008160:Lumbosacral Plexus; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012677:Sensation; D014549:Urinary Incontinence / Q000503:physiopathology*; D014563:Urodynamics