title: Bilateral caudal epidural neuromodulation for refractory urinary retention: a salvage procedure.
abstract: OBJECTIVE
  Sacral neuromodulation with InterStim is approved for idiopathic urinary retention with a success rate of approximately 69%. To our knowledge currently no alternatives exist for patients in whom S3 neuromodulation fails. We report a new technique and our experience with bilateral caudal epidural neuromodulation in patients in urinary retention in whom unilateral or bilateral S3 InterStim failed.
  
  
  METHODS
  Eight patients with multifactorial urinary retention in whom S3 InterStim previously failed underwent retrograde placement of bilateral tined leads into the caudal epidural space for sacral nerve stimulation. Patients with a 50% or greater clinical response underwent stage 2 Synergy-Versitrel implantable pulse generator placement. Patients were evaluated with voiding diaries, the Urinary Distress Inventory Questionnaire short form, quality of life assessment, need for catheterization and post-void residual urine preoperatively, and 6 months after implantation.
  
  
  RESULTS
  Five of the 8 patients experienced return of micturition and underwent placement of a permanent implantable pulse generator. At 6-month followup 4 of the 5 patients voided to completion. One patient improved more than 50% and now catheterizes once daily with a post-void residual urine of 200 cc. There was a significant decrease in obstructive symptoms on the Urinary Distress Inventory Questionnaire short form and improved overall quality of life.
  
  
  CONCLUSIONS
  To our knowledge this is the first report of the use of bilateral caudal epidural neuromodulation for refractory urinary retention. This therapy can be successful in patients in whom prior InterStim therapy failed.
authors.affiliation: The Urology Center, New Haven, Connecticut, USA.
authors.forename: Mary Grey
authors.initials: MG
authors.lastname: Maher
authors.forename: Arthur
authors.initials: A
authors.lastname: Mourtzinos
authors.forename: Nasim
authors.initials: N
authors.lastname: Zabihi
authors.forename: U Zehra
authors.initials: UZ
authors.lastname: Laiwalla
authors.forename: Shlomo
authors.initials: S
authors.lastname: Raz
authors.forename: Larissa V
authors.initials: LV
authors.lastname: Rodríguez
mesh_terms: D000328:Adult; D000368:Aged; D002420:Cauda Equina; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D004824:Epidural Space; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016879:Salvage Therapy; D016055:Urinary Retention / Q000628:therapy*