Division of Urology
CIUSSS de l’Estrie - CHUS
Retrospective study of the long-term efficacy of sacral nerve stimulation in underactive bladder patients: A single institution experience
Cristina Alina Evoescu1, Salima Ismail1, Béatrice Bouchard1, Le Mai Tu1.
1Surgery Department/Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
Currently, sacral nerve stimulation (SNS) remains the only surgical treatment approved by the U.S. Food and Drug Administration for cases of underactive bladder (UAB) without bladder outlet obstruction. It has been showed to be effective in reducing the need for clean intermittent catherization (CIC) and post void residual volume (PVR). Nevertheless, UAB and SNS have only recently sparked interest in the research community. The objective of this research is to assess the long-term functional outcomes of SNS for UAB treatment.
All consecutive patients suffering from UAB and treated by SNS at the Centre Hospitalier Universitaire de Sherbrooke between July 2007 and August 2019 were included. Data regarding patient demographics, SNS parameters, revision rates, complication and outcomes of stimulation were collected.
24 patients with a median age of 56.5 years (IQR 53-61) were included. All procedures had been done under local anaesthesia with light intravenous sedation. Median follow-up time was of 52.5 months (IRQ 20.3-116.3). Fifteen patients (62,5%) had bilateral and 9 patients (37.5%) had unilateral SNS. PVR and number of CIC decreased of 61% and 73% from baseline to last follow-up (see table). CIC has been completely stopped in 11 patients (45.8%). Revision surgeries were performed in 11 patients for broken electrode (n=6, 25.0%) and displaced electrode (n=2, 8.3%). SNS devices were permanently removed in 2 (12.5%) patients due to important unpleasant motor contractions and lack of efficacy. There was infection (2.4%) secondary to the chronic cutaneous Staphylococcus Aureus infection. The device was repositioned in an antibiotic coated pouch and repositioned in a different site without further complication.
Patients with UAB showed an important reduction of PVR and number of CIC with SNS. Moreover, it is a well-tolerated minimally invasive therapy that requires few revision surgeries. This supports the role of SNS in the treatment of UAB in a subgroup of patients.
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