title: Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation.
abstract: OBJECTIVE
  We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures.
  
  
  METHODS
  A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (> or =80% improvement), moderate response (> or =50% and <80% improvement), and poor response (<50% response).
  
  
  RESULTS
  Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters.
  
  
  CONCLUSIONS
  Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, Tennessee 37232-2765, USA. jonathan.s.starkman@vanderbilt.edu
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Starkman
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Wolter
authors.forename: Harriette M
authors.initials: HM
authors.lastname: Scarpero
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Milam
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery / Q000628:therapy; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012447:Sacrum / Q000294:innervation; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D053202:Urinary Incontinence, Urge / Q000601:surgery* / Q000628:therapy*; D014596:Uterine Prolapse / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000601:surgery