title: Sacral neuromodulation in patients with multiple sclerosis.
abstract: OBJECTIVE
  We present a case series of patients with multiple sclerosis (MS) and neurogenic lower urinary tract dysfunction treated by sacral neuromodulation (SNM).
  
  
  METHODS
  We reviewed charts of 25 patients who were treated for refractory lower urinary tract symptoms; during the SNM testing phase, patient management included evaluation of number of daily voiding, number of episodes of incontinence, residual urine and quality of life score. Patients who experienced greater than 50% improvement in symptoms of frequency and incontinence episodes and/or a greater than 50% decrease in the number of catheterizations and a greater than 50% increase in voided volumes were offered placement of the permanent InterStim(TM) .
  
  
  RESULTS
  Fifteen patients were implanted with InterStim(TM); mean duration of MS was 13.66 years; mean follow-up of patients was 49.4 months. Nine patients were on clean intermittent catheterization, and in all of them, a significant decrease in residual volume with increase in voided volume and number of voiding per day; in 6 patients, the main problem was incontinence, and in them incontinence, episodes decreased and voided volume increased. Sixty-six per cent of patients have a functioning device after a mean follow-up of 61.2 months.
  
  
  CONCLUSIONS
  SNM is a good option in the treatment of voiding dysfunction in patients with MS in a medium to long-term follow-up. Urinary retention due to detrusor underactivity is not a good indication for SNM; it should be offered to MS patients with refractory urgency urinary incontinence and MS patients with urinary retention due to detrusor-sphincter dyssynergia (DSD).
authors.affiliation: Department of Clinic and Specialistic Sciences-Urology, Polytechnic University of the Marches Region-Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy. d.minardi@univpm.it
authors.forename: Daniele
authors.initials: D
authors.lastname: Minardi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muzzonigro
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000628:therapy*; D008160:Lumbosacral Plexus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy; D016055:Urinary Retention / Q000209:etiology / Q000628:therapy; D014555:Urination Disorders / Q000209:etiology / Q000628:therapy*