title: Sacral neuromodulation for treating neurogenic bladder dysfunction: clinical and urodynamic study.
abstract: OBJECTIVE
  The efficacy of sacral neuromodulation for treating refractory idiopathic lower urinary tract dysfunction is now well established. Nevertheless, results of this technique in neurological patients are still controversial. The aim of this retrospective study was to assess the results of sacral neuromodulation in neurogenic bladder dysfunction.
  
  
  METHODS
  Between 1998 and 2008, a percutaneous nerve evaluation or a two-stage technique was performed in 62 patients (mean age 50.5 ± 14.8 years) with neurogenic lower urinary tract dysfunction. Before and during the temporary stimulation, each patient had a urodynamic evaluation and performed a bladder diary. The test was considered positive if the clinical and urodynamic improvement was over 50% and if the symptoms reappeared after turning the stimulation off.
  
  
  RESULTS
  Lower urinary tract dysfunction was detrusor overactivity in 34 cases and chronic urinary retention in 28 cases. A detrusor-sphincter dyssynergia (DSD) was associated in nine cases. Out of the 62 patients, 41 patients (66.1%) had more than 50% improvement on urodynamic evaluation and bladder diary and 37 were implanted. With a mean follow-up of 4.3 ± 3.7 years, results remained similar to the evaluation phase in 28 cases (75.7%), were partially altered in three cases (8.1%) and lost in six cases (16.2%). In these six cases, neuromodulation failed on average 12.0 ± 12.4 months after implantation.
  
  
  CONCLUSIONS
  Sacral neuromodulation seems to constitute a serious therapeutic option for patients with neurogenic lower urinary tract dysfunction. However, its results depend on the type of the underlying neurologic disease and in particular, whether it may progress or not.
authors.affiliation: Service d'Urologie, Andrologie et Transplantation Rénale, Toulouse, France.
authors.forename: Wassim
authors.initials: W
authors.lastname: Chaabane
authors.forename: Julien
authors.initials: J
authors.lastname: Guillotreau
authors.forename: Evelyne
authors.initials: E
authors.lastname: Castel-Lacanal
authors.forename: Sami
authors.initials: S
authors.lastname: Abu-Anz
authors.forename: Xavier
authors.initials: X
authors.lastname: De Boissezon
authors.forename: Bernard
authors.initials: B
authors.lastname: Malavaud
authors.forename: Philippe
authors.initials: P
authors.lastname: Marque
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Sarramon
authors.forename: Pascal
authors.initials: P
authors.lastname: Rischmann
authors.forename: Xavier
authors.initials: X
authors.lastname: Game
mesh_terms: D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008160:Lumbosacral Plexus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics / Q000502:physiology