Sacral Nerve Modualtion outcomes in patients with Chronic Urinary Retention and Voiding Dysfunction over 5 years - 388 patient case study

Khan B1, Gonzales G1, Elneil S1

Research Type

Clinical

Abstract Category

Neurourology

Abstract 440
Neuromodulation
Scientific Podium Short Oral Session 22
Thursday 30th August 2018
15:07 - 15:15
Hall A
Neuromodulation Retrospective Study Voiding Dysfunction Voiding Diary
1. The National Hospital for Neurology and Neurosurgery, UCLH
Presenter
B

Baha Khan

Links

Abstract

Hypothesis / aims of study
To identify the success rate of sacral nerve modulation in patients with chronic urinary retention (CUR) and voiding dysfunction (VD), identified as having primary urethral dysfunction (Fowlers syndrome).
Study design, materials and methods
Retrospective data was collected between January 2013 till January 2018 (5-year period) in the uro-neurology department. All the patients were diagnosed with urinary retention due to primary urethral dysfunction identified using cystometography (flow rate and post void residual measurements), urethral sphincter volume, urethral pressure profile and urethral electromyography (EMG). All patients underwent sacral nerve modulation (SNM) at the same unit under a single surgeon. This was carried out using the two-stage approach, with electrode insertion (stage 1) followed by battery insertion (stage 2) if stage one was deemed to be successful. The primary outcome measure was success rate of SNM. This was identified using improvement in quality of life as well as objectively using bladder diaries and flow rate and PVR measurements The failure rate was separated into primary failure after stage 1, true failure of the electrode and secondary failure (after insertion of the battery). Secondary complications were also identified including infection, pain, medical complications, displaced electrode.

No ethical submission was required.
Results
A total of 388 patients were identified in this study. 369 patients were women, 17 were male and 2 were transgender. The overall success rate for SNM in patients with CUR was 85%. In male patients it was 82% whereas in women it was 86%. The overall primary failure rate was 10% and secondary failure rate was identified as 5%. The infection rate was 5%. 
29 patients (7%) were identified to have had a successful SNM but required removal of the device. Of these patients 48% required removal due to infection, 17% as due to requiring MRI imaging for other pathology, 17% due to patient request, 14% due to pain and 4% due to pregnancy.
18 patients complained of other complications but despite these felt the benefit outweighed the complications and therefore the SNM device was left in situ. Of these patients 44% complained of battery site pain, 27% complained of leg pain, 11% complained of groin pain, 6% (1 patient) suffered from a haematoma, 6% (1 patient) suffered from a DVT and 6% (1 patient) complained of toe curling.
Interpretation of results
There was significant improvement in chronic urinary retention in both male and female patients with sacral nerve modulation. The overall infection rate of 5% is an appropriate risk in this surgery.
Concluding message
Sacral nerve modulation has a very high success rate in patients with chronic urinary retention with voiding dysfunction and should be considered as the gold standard in treatment for these patients.
Disclosures
Funding No funding Clinical Trial No Subjects Human Ethics not Req'd This was a clinicla case series with retrospective data collection Helsinki Yes Informed Consent Yes