title: Five-Year Follow-up After Sacral Neuromodulation: Single Center Experience.
abstract: Objective.  We studied long-term clinical efficacy of sacral neuromodulation (SNM) therapy in patients with refractory urgency incontinence (UI), urgency/frequency (UF) and voiding difficulty (VD), together with urodynamic data at baseline and six months postimplant. Materials and Methods.  Twenty-two patients were implanted with a neurostimulator after a positive response to a percutaneous nerve evaluation test defined as a greater than 50% improvement in symptoms. Results.  At five-year follow-up, the number of incontinent episodes and pad usage per day decreased significantly in 10 out of 15 UI patients. Two of five UF patients were successfully treated with SNM; the number of daily voids for all UF patients decreased from 25 to 19 and average voided volume increased from 98 to 212 mL. One of the two VD patients was able to void to completion. Mean first sensation of filling at the six-month urodynamic investigation for the UI and UF patients increased from 78 to 241 mL and 141 to 232 mL, respectively, and the maximum bladder capacity increased from 292 to 352 mL and 223 to 318 mL, respectively. Five of 22 patients underwent device explant and one patient still has an inactive stimulator implanted. Conclusion.  SNM is an effective treatment modality that offers sustained clinical benefit in the majority of patients with refractory UI, UF, and VD that do not respond to other, more conservative therapies.
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands; and              Medtronic Interstim, Maastricht, The Netherlands.
authors.forename: Pieter M
authors.initials: PM
authors.lastname: Groenendijk
authors.forename: August A B
authors.initials: AA
authors.lastname: Lycklama À Nijeholt
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Ouwerkerk
authors.forename: Ubi
authors.initials: U
authors.lastname: van den Hombergh