Sacral neurostimulation for urinary retention: 10-year experience from one UK centre.
OBJECTIVE
To report our 10-year experience of sacral neurostimulation (SNS) for women in urinary retention, comparing the original one-stage with the newer two-stage technique, as SNS therapy is a well-established treatment for urinary retention secondary to urethral sphincter overactivity (Fowler's syndrome).


METHODS
Between 1996 and 2006, 60 patients with urinary retention had a SNS device inserted; their case records were reviewed and data on efficacy, follow-up, need for continued clean intermittent self-catheterization (CISC), complications and operative revision rate were assessed.


RESULTS
Overall, 43 of 60 (72%) women were voiding spontaneously, with a mean postvoid residual volume of 100 mL; 30 (50%) no longer needed to use CISC. During a total of 2878 months of SNS experience, adverse event episodes included lead migration in 20, 'box-site' pain in 19, leg pain/numbness in 18 and loss of response/failure in 18 patients; 53% of the women required a surgical revision related to their implanted stimulator. The efficacy of the two-stage was similar to that of the one-stage procedure (73% vs 70%). Women with a normal urethral sphincter electromyogram had worse outcomes than women with an abnormal test (43% vs 76%). Although the efficacy was no different in those taking analgesia/antidepressant medication, this group of women had a higher surgical revision rate. Failure and complications for the one-stage procedure were not restricted to the early follow-up period. The mean battery life of the implant was 7.31 years.


CONCLUSIONS
SNS has sustained long-term efficacy but the procedure has a significant complication rate. At present, the two-stage technique has comparable efficacy to the one-stage technique but a longer-term follow-up is required. The National Institute of Clinical Excellence recommended the use of SNS in women with urinary incontinence who fail to respond adequately to anticholinergic therapy, but patients choosing this treatment should be made aware of the high complication rate associated with the procedure.
Datta
Soumendra N
SN
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
Chaliha
Charlotte
C
Singh
Anubha
A
Gonzales
Gwen
G
Mishra
Vibhash C
VC
Kavia
Rajesh B C
RB
Kitchen
Neil
N
Fowler
Clare J
CJ
Elneil
Sohier
S
D000328:Adult; D015331:Cohort Studies; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus; D008485:Medical Audit; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D016055:Urinary Retention / Q000503:physiopathology / Q000628:therapy*; D014554:Urination / Q000502:physiology; D014563:Urodynamics / Q000502:physiology*