Journal List > Korean J Urol > v.48(7) > 1004958

TOOLS
Chung, Han, and Lee: Efficacy and Safety of Sacral Neuromodulation (Interstim®) for the Treatment of Refractory Overactive Bladder Symptoms and Chronic Pelvic Pain
Original Article
Korean Journal of Urology

Korean Journal of Urology 2007; 48(7): 701-705.

Published online: 31 July 2007

DOI: https://doi.org/10.4111/kju.2007.48.7.701

Efficacy and Safety of Sacral Neuromodulation (Interstim®) for the Treatment of Refractory Overactive Bladder Symptoms and Chronic Pelvic Pain

Jin Woo Chung, Deok Hyun Han, Kyu-Sung Lee

Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (lks@smc.samsung.co.kr)

Received 20 April 2007       Accepted 7 June 2007

Copyright © 2007 The Korean Urological Association

Abstract

Purpose

We evaluated the efficacy and safety of sacral neuromodulation for treating the patients suffering with an overactive bladder (OAB) or chronic pelvic pain (CPP) that was refractory to conservative therapies.

Materials and Methods

Between November 2002 and May 2006, a total of 30 patients underwent testing with sacral nerve modulation via either a traditional percutaneous approach or a staged procedure to predict the efficacy of this treatment for refractory OAB and/or CPP. 17 patients had 50% or greater improvement in their presenting symptoms and they underwent a procedure to implant a permanent sacral nerve stimulator. The results of the treatment were evaluated according to the 3 day-voiding records, the severity of pain, the patients' perception of their bladder condition and the benefits of the treatment.

Results

Twelve patients had CPP and 5 had OAB. The number and severity of their urgency episodes were improved. However, the number of times they passed urine was not significantly changed. The number of incontinence episodes was reduced for the 7 patients who suffered with urge incontinence. For 12 patients with CPP, the severity of their average pain was significantly decreased. There was a reduction in the number of the patients with a moderate or more severe bladder condition, from 17 to 10, after sacral neuromodulation. The overall rate of the patients' perceiving treatment benefit was 53%. The complications were lower limb numbness in 2 cases, wound infection in 1, foreign body sensation in 1, anal pain in 1 and lead migration in 1.

Conclusions

Sacral Neuromodulation using Interstim® significantly improves the OAB symptoms and CPP in the patients who did not respond to other therapies.

Keywords: Overactive bladder, Interstitial cystitis, Chronic pelvic pain

Figures and Tables

Fig. 1
Patient's perception of their bladder condition.
kju-48-701-g001
Table 1
Patient characteristics. The data in parentheses are percentages
kju-48-701-i001
Table 2
Changes in the clinical parameters after sacral neuromodulation Parameters
kju-48-701-i002

*measued by Five-point urgency rating scale. SNM: sacral neuromodulation, VAS: visual analogue scale

Table 3
Description of adverse events
kju-48-701-i003

References

1. Bernstein AJ, Peters KM. Expanding indications for neuromodulation. Urol Clin North Am. 2005. 32:59–63.
2. Aboseif S, Tamaddon K, Chalfin S, Freedman S, Kaptein J. Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction. Urology. 2002. 60:52–56.
3. European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products. CPMP/EWP/18/01. Note for guidance on the clinical investigation of medicinal products for the treatment of urinary incontinence. 2002. 12. London:
4. Coyne KS, Matza LS. Validation of the perception of bladder condition measure in overactive bladder. 2002. In : 7th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research; Arlington, VA.
5. Schmidt RA. Advances in genitourinary neurostimulation. Neurosurgery. 1986. 19:1041–1044.
6. Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol. 1988. 140:1331–1339.
7. van Voskuilen AC, Oerlemans DJ, Weil EH, de Bie RA, van Kerrebroeck PE. Long term results of neuromodulation by sacral nerve stimulation for lower urinary tract symptoms: a retrospective single center study. Eur Urol. 2006. 49:366–372.
8. Jonas U, Fowler CJ, Chancellor MB, Elhilali MM, Fall M, Gajewski JB, et al. Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol. 2001. 165:15–19.
9. Spinelli M, Bertapelle P, Cappellano F, Zanollo A, Carone R, Catanzaro F, et al. Chronic sacral neuromodulation in patients with lower urinary tract symptoms: results from a national register. J Urol. 2001. 166:541–545.
10. Comiter CV. Sacral neuromodulation for the symptomatic treatment of refractory interstitial cystitis: a prospective study. J Urol. 2003. 169:1369–1373.
11. Kessler TM, Buchser E, Meyer S, Engeler DS, Al-Khodairy AW, Bersch U, et al. Sacral neuromodulation for refractory lower urinary tract dysfunction: results of a nationwide registry in Switzerland. Eur Urol. 2007. 51:1357–1363.
12. Siegel SW, Catanzaro F, Dijkema HE, Elhilali MM, Fowler CJ, Gajewski JB, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology. 2000. 56(6):Suppl 1. 87–91.
13. Shaker HS, Hassouna M. Sacral nerve root neuromodulation: an effective treatment for refractory urge incontinence. J Urol. 1998. 159:1516–1519.
14. Siegel SW. Management of voiding dysfunction with an implantable neuroprosthesis. Urol Clin North Am. 1992. 19:163–170.
15. Janknegt RA, Weil EH, Eerdmans PH. Improving neuromodulation technique for refractory voiding dysfunctions: two-stage implant. Urology. 1997. 49:358–362.
16. Chai TC, Mamo GJ. Modified techniques of S3 foramen localization and lead implantation in S3 neuromodulation. Urology. 2001. 58:786–790.
17. Spinelli M, Giardiello G, Arduini A, van den Hombergh U. New percutaneous technique of sacral nerve stimulation has high initial success rate: preliminary results. Eur Urol. 2003. 43:70–74.
18. Spinelli M, Giardiello G, Gerber M, Arduini A, van den Hombergh U, Malaguti S. New sacral neuromodulation lead for percutaneous implantation using local anesthesia: description and first experience. J Urol. 2003. 170:1905–1907.
TOOLS
Similar articles