Categorized | Bladder Health, Feature

Sacral Neuromodulation Treats Refractory Idiopathic Urge Urinary Incontinence

According to Dutch researchers, sacral neuromodulation could be a safe, if impermanent, way to treat refractory idiopathic urge urinary incontinence.

Sacral neuromodulation, also known as sacral nerve stimulation, involves the implantation of a programmable stimulator subcutaneously which delivers low amplitude electrical stimulation through a lead to the sacral nerve, usually accessed via the S3 forament.

In a new study published in a recent issue of the Journal of Urology, Jan Groen, Ph.D., Bertil F.M. Blok, M.D., Ph.D., and J.L.H. Ruud Bosch, M.D., all from the Erasmus Medical Center in Rotterdam and University Medical Center Utrecht (JLHRB), Utrecht, The Netherlands, report on 60 women who had leads for sacral neuromodulation implanted by open surgery.

Eighty-seven percent of the women had at least a 50 percent decrease in incontinence episodes or the number of pads used daily at one month.

By five years, however, only 62 percent of the women were still reporting at least a 50 percent decrease from baseline.  Additionally, only 15 percent were completely continent.  Over half (32 patients) had 57 adverse events; most involved hardware or pain and discomfort. None were serious.

The study’s lead author Groen said that despite its decreasing effectiveness, neuromodulation “remains our first choice, especially in younger patients, as the technique is safe, does not need frequent re-treatment and is not accompanied by a possible need for self-catheterization.”

He does, however, acknowledge that the relative place of neuromodulation in the treatment algorithm and the role of its most important alternative option, botulinum toxin, are evolving.

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