title: Sacral neuromodulation in diabetic patients: success and complications in the treatment of voiding dysfunction.
abstract: OBJECTIVE
  We compared success rates, subsequent complications, and possible indications for success of sacral neuromodulation (SNM) for urinary voiding dysfunction in diabetic and non-diabetic patients.
  
  
  METHODS
  Thirty-two diabetic patients (mean age 61.8 years, range 27-83) with urge incontinence, urgency-frequency syndrome, and/or urinary retention refractory to non-surgical treatment were retrospectively evaluated along with 211 non-diabetic patients (mean age 54.1 years, range 20-86) with similar symptoms. All patients who experienced >or=50% reduction in urinary symptoms following a 7- to 21-day test period went on to permanent SNM device implantation.
  
  
  RESULTS
  No significant difference was found with respect to successful conversion rates from the test period to permanent implantation between diabetic and non-diabetic patients. Long-term success rates at a mean followup of 29.3 months following permanent device implantation for diabetic patients were 69.2% of those with urge incontinence, 85.7% of those with urgency-frequency, and 66.7% of those with urinary retention. The non-diabetic cohort had success rates of 67.0% for urge incontinence, 67.8% for urgency/frequency, and 58.2% for urinary retention (P = 0.823, 0.157, and 0.631, respectively). No patient experienced intraoperative complications. Nine of 24 (37.5%) devices were explanted postoperatively in diabetic patients compared with 36 of 141 (25.5%) in non-diabetic patients (P = 0.224). The number of explants due to infection was higher in diabetic patients (16.7%) versus non-diabetic patients (4.3%; P = 0.018).
  
  
  CONCLUSIONS
  No difference in long-term success rates was seen in diabetic patients when compared with similar, non-diabetic patients. Diabetic patients did, however, have a higher incidence of device explantation due to infection.
authors.affiliation: Department of Urology, University of Iowa, Iowa City, Iowa 52242-1089, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Daniels
authors.forename: Charles R
authors.initials: CR
authors.lastname: Powell
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Braasch
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Kreder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000503:physiopathology*; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation* / Q000503:physiopathology; D014549:Urinary Incontinence / Q000503:physiopathology / Q000628:therapy*; D053202:Urinary Incontinence, Urge / Q000628:therapy; D016055:Urinary Retention / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics