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Urodynamic evaluation of sacral neuromodulation for urge urinary incontinence.
BJU Int. 2008 Feb; 101(3):325-9.BI

Abstract

OBJECTIVE

To evaluate the urodynamic data before and 6 months after implantation of sacral neuromodulation (SNM, an established treatment for voiding dysfunction, including refractory urge urinary incontinence, UI) and to assess the correlation between the urodynamic data and clinical efficacy in patients with UI.

PATIENTS AND METHODS

In all, 111 patients with a >50% reduction in UI symptoms during a percutaneous nerve evaluation test qualified for surgical implantation of SNM. Patients were categorized in two subgroups, i.e. those with UI with or without confirmed detrusor overactivity (DO) at baseline. At the 6-month follow-up all patients had a second urodynamic investigation, with the stimulator switched on.

RESULTS

At baseline, there was urodynamically confirmed DO in 67 patients, while 44 showed no DO. A review of filling cystometry variables showed a statistically significant improvement in bladder volumes at first sensation of filling (FSF) and at maximum fill volume (MFV) before voiding for both UI subgroups, compared with baseline. In 51% of the patients with UI and DO at baseline, the DO resolved during the follow-up. However, those patients were no more clinically successful than those who still had DO (P = 0.73). At the 6-month follow-up, 55 of 84 implanted patients showed clinical benefit, having a >or=50% improvement in primary voiding diary variables. Patients with UI but no DO had a higher rate of clinical success (73%) than patients with UI and DO (61%), but the difference was not statistically significant.

CONCLUSION

These urodynamic results show a statistically significant improvement in FSF and MFV in patients with UI with or with no DO after SNM. Although there was a urodynamic and clinical improvement in both groups, patients with UI but no DO are at least as successful as patients with UI and DO. Therefore in patients with UI, DO should not be a prerequisite selection criterion for using SNM.

Authors+Show Affiliations

Leiden University Medical Centre, Leiden, The Netherlands. groenenp@rdgg.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

18070199

Citation

Groenendijk, Pieter M., et al. "Urodynamic Evaluation of Sacral Neuromodulation for Urge Urinary Incontinence." BJU International, vol. 101, no. 3, 2008, pp. 325-9.
Groenendijk PM, Lycklama à Nyeholt AA, Heesakkers JP, et al. Urodynamic evaluation of sacral neuromodulation for urge urinary incontinence. BJU Int. 2008;101(3):325-9.
Groenendijk, P. M., Lycklama à Nyeholt, A. A., Heesakkers, J. P., van Kerrebroeck, P. E., Hassouna, M. M., Gajewski, J. B., Cappellano, F., Siegel, S. W., Fall, M., Dijkema, H. E., Jonas, U., & van den Hombergh, U. (2008). Urodynamic evaluation of sacral neuromodulation for urge urinary incontinence. BJU International, 101(3), 325-9.
Groenendijk PM, et al. Urodynamic Evaluation of Sacral Neuromodulation for Urge Urinary Incontinence. BJU Int. 2008;101(3):325-9. PubMed PMID: 18070199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urodynamic evaluation of sacral neuromodulation for urge urinary incontinence. AU - Groenendijk,Pieter M, AU - Lycklama à Nyeholt,August A B, AU - Heesakkers,John P F A, AU - van Kerrebroeck,Philip E V, AU - Hassouna,Magdy M, AU - Gajewski,Jerzy B, AU - Cappellano,Francesco, AU - Siegel,Steven W, AU - Fall,Magnus, AU - Dijkema,Hero E, AU - Jonas,Udo, AU - van den Hombergh,Ubi, AU - ,, Y1 - 2007/12/05/ PY - 2007/12/12/pubmed PY - 2008/2/9/medline PY - 2007/12/12/entrez SP - 325 EP - 9 JF - BJU international JO - BJU Int VL - 101 IS - 3 N2 - OBJECTIVE: To evaluate the urodynamic data before and 6 months after implantation of sacral neuromodulation (SNM, an established treatment for voiding dysfunction, including refractory urge urinary incontinence, UI) and to assess the correlation between the urodynamic data and clinical efficacy in patients with UI. PATIENTS AND METHODS: In all, 111 patients with a >50% reduction in UI symptoms during a percutaneous nerve evaluation test qualified for surgical implantation of SNM. Patients were categorized in two subgroups, i.e. those with UI with or without confirmed detrusor overactivity (DO) at baseline. At the 6-month follow-up all patients had a second urodynamic investigation, with the stimulator switched on. RESULTS: At baseline, there was urodynamically confirmed DO in 67 patients, while 44 showed no DO. A review of filling cystometry variables showed a statistically significant improvement in bladder volumes at first sensation of filling (FSF) and at maximum fill volume (MFV) before voiding for both UI subgroups, compared with baseline. In 51% of the patients with UI and DO at baseline, the DO resolved during the follow-up. However, those patients were no more clinically successful than those who still had DO (P = 0.73). At the 6-month follow-up, 55 of 84 implanted patients showed clinical benefit, having a >or=50% improvement in primary voiding diary variables. Patients with UI but no DO had a higher rate of clinical success (73%) than patients with UI and DO (61%), but the difference was not statistically significant. CONCLUSION: These urodynamic results show a statistically significant improvement in FSF and MFV in patients with UI with or with no DO after SNM. Although there was a urodynamic and clinical improvement in both groups, patients with UI but no DO are at least as successful as patients with UI and DO. Therefore in patients with UI, DO should not be a prerequisite selection criterion for using SNM. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/18070199/Urodynamic_evaluation_of_sacral_neuromodulation_for_urge_urinary_incontinence_ L2 - https://doi.org/10.1111/j.1464-410X.2007.07258.x DB - PRIME DP - Unbound Medicine ER -