Sacral neuromodulation for refractory lower urinary tract dysfunction: results of a nationwide registry in Switzerland.
OBJECTIVE
To assess the efficacy and safety of sacral neuromodulation (SNM) in patients with refractory lower urinary tract dysfunction in Switzerland based on a nationwide registry.


METHODS
A total of 209 patients (181 females, 28 males) underwent SNM testing between July 2000 and December 2005 in Switzerland. Subjective symptom improvement, bladder/pain diary variables, adverse events, and their management were prospectively registered.


RESULTS
SNM testing was successful (defined as improvement of more than 50% in bladder/pain diary variables) in 102 of 209 patients (49%). An implantable pulse generator (IPG) was placed in 91 patients (89% of all successfully tested and 44% of all tested patients). Of the IPG-implanted patients, 71 had urge incontinence, 13 nonobstructive chronic urinary retention, and 7 chronic pelvic pain syndrome. After a median follow-up of 24 mo, SNM was successful in 64 of the 91 IPG-implanted patients (70%) but failed in 27 patients. SNM was continued in 15 of the 27 patients considered failures, because following troubleshooting SNM response improved subjectively and the patients were satisfied. However, improvement in bladder/pain diary variables remained less than 50%. In the other 12 patients both the leads and the IPG were explanted. During the test phase and during/following IPG implantation, 6% (12 of 209) and 11% (10 of 91) adverse event rates and 1% (3 of 209) and 7% (6 of 91) surgical revision rates were reported, respectively.


CONCLUSIONS
SNM is an effective and safe treatment for refractory lower urinary tract dysfunction. Adverse events are usually transient and can be treated effectively.
Kessler
Thomas M
TM
Department of Urology, University of Bern, 3010 Bern, Switzerland. tkessler@gmx.ch
Buchser
Eric
E
Meyer
Sylvain
S
Engeler
Daniel S
DS
Al-Khodairy
Abdul-Wahab
AW
Bersch
Ulf
U
Iselin
Christophe E
CE
Roche
Bruno
B
Schmid
Daniel M
DM
Schurch
Brigitte
B
Zrehen
Stephane
S
Burkhard
Fiona C
FC
D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012042:Registries; D013557:Switzerland; D014555:Urination Disorders / Q000175:diagnosis / Q000628:therapy*