The use of bilateral sacral nerve stimulation in patients with loss of unilateral treatment efficacy.
OBJECTIVE
We evaluated whether bilateral sacral nerve stimulation can be effective to restore treatment efficacy in patients in whom unilateral sacral neuromodulation fails.


METHODS
Patients in whom unilateral sacral neuromodulation failed were included in analysis. The percutaneous nerve evaluation test was used to evaluate the effect of contralateral and bilateral stimulation. The stimulation electrode was placed in the contralateral S3 foramen and symptoms were self-recorded using a 3-day voiding diary. Clinical success was defined as more than 50% improvement in at least 1 relevant voiding diary parameter vs baseline.


RESULTS
The 15 study patients underwent test stimulation with percutaneous nerve evaluation. In 3 patients lead migration was suspected and, thus, they were not included in analysis. Four of the remaining 12 patients had a successful response to percutaneous nerve evaluation, of whom 3 were eventually implanted with a contralateral lead. After 12 months of treatment 2 of the 3 patients had a successful outcome.


CONCLUSIONS
In this pilot study only a select group of patients appeared to benefit from bilateral stimulation after unilateral therapy failure. Further investigation is needed to determine the predictive factors and cost-effectiveness of this treatment.
Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Tom A T
TA
Marcelissen
Randall K
RK
Leong
Jan
J
Serroyen
Philip E V
PE
van Kerrebroeck
Stefan G G
SG
De Wachter
D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D053201:Urinary Bladder, Overactive / Q000628:therapy*