title: Sacral neuromodulation for detrusor hyperactivity with impaired contractility.
abstract: BACKGROUND
  Detrusor hyperactivity with impaired contractility (DHIC) is a challenging condition to manage. Sacral neuromodulation (SNM) is a proven treatment modality for both the individual aspects of DHIC. To date, data reporting the outcome of SNM for DHIC are lacking.
  
  
  METHODS
  Consecutive patients undergoing SNM for DHIC were followed prospectively, from April 2013 to October 2016. Patient demographics, bladder diaries, subjective response rates, ICIQ-OAB, and PGI-I scores were recorded. Success was defined as greater than 50% improvement in storage symptoms and a 50% improvement in voided volume or reduction of post-void residual volumes.
  
  
  RESULTS
  Twenty patients underwent stage 1 trial of SNM for DHIC. Median age was 68.5, IQR (54.25-76.25). Thirteen (65%) patients were female. A total of 14/20 (70%) of patients had a significant treatment response, 9/20 had a response to both elements of DHIC, 4/20 patients had a response to the detrusor overactivity (DO) alone, and 1/20 had a response to the voiding component alone. A total of 12/20 (60%) patients proceeded to insertion of an IPG. At mean follow-up of 17 months, IQR (1.5-35), 11/12 (91.7%) of patients are still using the SNM for DHIC. Median PGI score is 2, IQR (2-4). SNM for DHIC resulted in statistically significant improvements in voided volume (P = 0.016), PVR (P = 0.0296), ICIQ-OAB score (P < 0.0001), and ICIQ-OAB bother score (P = 0.016) CONCLUSION: This is the first study we know of to report the results of SNM for DHIC. SNM is associated with satisfactory success rates, treating both the detrusor hyperactivity, and impaired contractility components of this condition.
authors.affiliation: Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Derek B
authors.identifier: http://orcid.org/0000-0002-7372-0100
authors.initials: DB
authors.lastname: Hennessey
authors.affiliation: Department of Urology, Victoria General Hospital, Victoria, British Columbia, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Hoag
authors.affiliation: Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Johan
authors.initials: J
authors.lastname: Gani
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D012447:Sacrum; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000503:physiopathology / Q000628:therapy*; D014554:Urination / Q000502:physiology*
keywords: DHIC; detrusor hyperactivity with impaired contractility; detrusor overactivity; sacral neuromodulation