Sacral neuromodulation in urological indications: the Finnish experience.
OBJECTIVE
Sacral neuromodulation is a treatment modality for voiding dysfunction that is resistant to conventional medical and surgical treatments. In Finland, sacral neuromodulation has been used for the treatment of urgency-frequency syndrome, non-obstructive urinary retention and painful bladder/interstitial cystitis since 1996.


METHODS
The investigation retrospectively evaluated 180 tested patients, 74 of whom underwent permanent implantation of the InterStim device.


RESULTS
A positive test result leading to implantation was significantly more frequent among females than males. Among urinary retention patients, the patients with a positive test leading to implantation were significantly younger than those without implantation. The implantation operation time was significantly shorter when using a tined lead device compared with open electrode insertion (76 vs 122 min). The mean follow-up time was 41 months (range 0-143). Significant improvement after implantation was noted in the mean urinated volumes and number of daily urinations, as well as in the number of catheterizations in urgency-frequency syndrome and urinary retention, respectively. The subjective long-term outcome was similar in these indications. Surgical revision was required for 15 patients (20.3% of implanted patients).


CONCLUSIONS
The difference in gender distribution compared with earlier published series may be explained by a selection bias due to the limited referrals of female patients from gynaecologists. The results favour the use of a tined lead device because of the shorter operating room time. Furthermore, the outcome seems to be more favourable among patients with a staged implant procedure compared with a one-stage operation with a tined lead device.
Department of Surgery, Oulu University Hospital, Oulu, Finland. markku.vaarala@oulu.fi
Markku H
MH
Vaarala
Teuvo L J
TL
Tammela
Ilkka
I
Perttilä
Pekka
P
Luukkonen
Pekka
P
Hellström
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003556:Cystitis / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000503:physiopathology / Q000628:therapy*; D053202:Urinary Incontinence, Urge / Q000503:physiopathology / Q000628:therapy*; D016055:Urinary Retention / Q000503:physiopathology / Q000628:therapy*; D014554:Urination / Q000502:physiology; D014556:Urine / Q000502:physiology; D055815:Young Adult