title: Sacral neuromodulation in patients with idiopathic overactive bladder after initial botulinum toxin therapy.
abstract: OBJECTIVE
  We evaluated whether patients with overactive bladder and incontinence who discontinued intravesical botulinum toxin therapy can be successfully treated with sacral neuromodulation.
  
  
  METHODS
  All patients who were referred to our center after discontinuation of botulinum toxin-A between 2005 and 2010 were included in this observational study. All patients underwent test stimulation with sacral neuromodulation and were evaluated with voiding diaries. Success was defined as more than 50% improvement in leakage episodes. Successful test stimulation was subsequently followed by a definitive implant. Patient satisfaction with sacral neuromodulation therapy was evaluated 1 year after the definitive implant.
  
  
  RESULTS
  A total of 20 patients were included in the study. Of these patients 17 (85%) had discontinued botulinum toxin-A because of lack of efficacy and 3 had been treated successfully with botulinum toxin-A but requested a more permanent solution. The mean interval between the botulinum toxin-A and the sacral neuromodulation test stimulation was 23 months. In 14 patients (70%) the test stimulation was successful and they received a definitive implant. Of the 14 patients 5 even showed a decrease of greater than 90% in leakage episodes. One year after implantation 11 patients (79%) were satisfied with the sacral neuromodulation treatment.
  
  
  CONCLUSIONS
  Despite the small sample size, this study indicates that patients who are dissatisfied with or in whom botulinum toxin-A treatment fails can respond successfully to sacral neuromodulation. The success rate of the test stimulation was comparable to that of patients who have never been treated with botulinum toxin-A. The 1-year satisfaction rate was comparable that of patients without a history of botulinum toxin-A treatment.
authors.affiliation: Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Martijn A C
authors.initials: MA
authors.lastname: Smits
authors.forename: Dennis
authors.initials: D
authors.lastname: Oerlemans
authors.forename: Tom A T
authors.initials: TA
authors.lastname: Marcelissen
authors.forename: Philip E V
authors.initials: PE
authors.lastname: Van Kerrebroeck
authors.forename: Stefan G G
authors.initials: SG
authors.lastname: De Wachter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D012447:Sacrum; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000628:therapy*; D014549:Urinary Incontinence / Q000628:therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: BoNTA; CISC; IDO; OAB; PNE; PVR; SNM; TLP; botulinum toxin-A; botulinum toxins; clean intermittent self-catheterization; idiopathic detrusor overactivity; overactive; overactive bladder; percutaneous nerve evaluation; post-void residual; sacral neuromodulation; tined lead procedure; urge; urinary bladder; urinary incontinence