[Sacral neuromodulation as second-line treatment strategy for lower urinary tract symptoms of various aetiologies: experience of a German high-volume clinic].
BACKGROUND
Lower urinary tract symptoms (LUTS) are a common and multiform micturition disorder of various possible origins. Several second-line techniques are available in the event of first-line medicinal treatment failure. These include the intravesical injection of Botulinum toxin, bladder augmentation and sacral neuromodulation (SNM). This study presents current data and results from a prospective study of patients with LUTS of various aetiologies.


METHODS
Clinical success was investigated for all patients who underwent SNM for LUTS with or without urge incontinence caused by chronic pelvic pain syndrome, multiple sclerosis and idiopathic disease between May 2007 and December 2010. The preoperatively determined symptoms were compared with current follow-up data. Median follow-up time was 11 months (1 - 43).


RESULTS
A total of 47 patients were indicated for SNM over the investigated period. 80.9 % were female, median patient age was 67 years (19 - 84). The testing phase was successful in 38 cases (80.9 %) with 9 electrodes being explanted (19.1 %). In the case of idiopathic LUTS we could show a statistically significant increase of micturition volume and reduction of incontinence pad use. There was no statistically significant improvement of any micturition parameter for patients with multiple sclerosis, patients with chronic pelvic pain syndrome showed a statistically significant reduction of micturition frequency and a subjective improvement of symptoms in 75 %.


CONCLUSIONS
In the selected patient groups SNM is a promising and, in experienced hands, a low-complication second-line therapy for the treatment of LUTS of idiopathic aetiology. However, the general recommendation of SNM for multiple sclerosis and chronic pelvic pain syndrome patients cannot be given on the basis of our results. Further prospective, randomised multicentre studies are need to further refine the indications for SNM in LUTS of neurogenic and non-neurogenic origins.
Caritas-Krankenhaus St. Josef, Klinik für Urologie der Universität Regensburg, Regensburg, Deutschland. wolfgang.otto@klinik.uniregensburg.de
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Nowrotek
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Burger
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Wieland
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Rößler
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Denzinger
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D061847:Hospitals, High-Volume; D006801:Humans; D007223:Infant; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008160:Lumbosacral Plexus / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D001743:Urinary Bladder / Q000294:innervation; D053202:Urinary Incontinence, Urge / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics / Q000502:physiology; D055815:Young Adult