Long-term follow-up of sacral neuromodulation for lower urinary tract dysfunction.
OBJECTIVE
To report our long-term experience of sacral neuromodulation (SNM) for various lower urinary tract dysfunctions but with a focus on efficacy, safety, re-interventions and degree of success.


METHODS
This is a single tertiary referral centre study that included 217 patients (86% female) who received an implantable pulse generator (IPG) (Interstim™, Medtronic, Minneapolis, USA) between 1996 and 2010. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline, but was further stratified.


RESULTS
The mean duration of follow-up was 46.88 months. Success and cure rates were ≈70% and 20% for urgency incontinence, 68% and 33% for urgency frequency syndrome and 73% and 58% for idiopathic retention. In those patients with an unsuccessful therapy outcome, the mean time to failure was 24.6 months after implantation. There were 88 (41%) patients who had at least one device or treatment related surgical re-intervention. The re-intervention rate was 1.7 per patient with most of them (47%) occurring ≤2 years of follow-up.


CONCLUSIONS
SNM appears effective in the long-term with a success rate after definitive IPG implant of ≈70% and complete cure rates ranging between 20% and 58% depending on indication. Patients with idiopathic retention appear to do best. The re-intervention rate is high with most occurring ≤2 years of implantation. It is likely that with the newer techniques used, efficacy and re-intervention rates will improve.
Department of Urology, University Hospitals Leuven, Leuven, Belgium.
Karlien
K
Peeters
Arun
A
Sahai
Dirk
D
De Ridder
Frank
F
Van Der Aa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000379:methods; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000503:physiopathology / Q000628:therapy*; D016055:Urinary Retention / Q000503:physiopathology / Q000628:therapy*; D014554:Urination / Q000502:physiology*; D055815:Young Adult
Fowler's syndrome; Interstim™; idiopathic retention; lower urinary tract dysfunction; overactive bladder; sacral neuromodulation; urgency frequency syndrome; urgency incontinence; voiding dysfunction