Sacral neuromodulation for the treatment of refractory urinary urge incontinence after stress incontinence surgery.
OBJECTIVE
This study was undertaken to evaluate the response to sacral neuromodulation in women with refractory, nonobstructive urinary urge incontinence after stress incontinence surgery.


METHODS
We reviewed the medical records of women in whom sacral neuromodulation was performed for worsening or de novo urinary urge incontinence after a stress incontinence procedure. All patients had undergone preliminary test stimulation. Demographics, surgical and urogynecologic history, including bladder diary and pad weight test, and urodynamic parameters were evaluated.


RESULTS
Of 34 women, 22 (65%) responded to the test stimulation and underwent permanent lead implant. There was no difference between responders and nonresponders with respect to type of stress incontinence surgery. Incontinence or urodynamic parameters were not different between responders and nonresponders. Factors that were predictive of a positive response were women aged less than 55 years (P = .01), the test stimulation performed within 4 years of the stress incontinence procedure (P = .01), and evidence of pelvic floor muscle activity (P = .03).


CONCLUSIONS
Sacral neuromodulation is a viable option for the treatment of refractory urinary urge incontinence that occurs after stress urinary incontinence surgery. Older women with no pelvic floor activity who are remote from their incontinence surgery may have a suboptimal response.
Sherman
Neil D
ND
Division of Urology, Duke University Medical Center, Durham, NC 27710, USA. neil.sherman@duke.edu
Jamison
Margaret G
MG
Webster
George D
GD
Amundsen
Cindy L
CL
D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000503:physiopathology; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D014563:Urodynamics