Long-Term Functional Outcomes of S3 Sacral Neuromodulation for the Treatment of Idiopathic Overactive Bladder

Chartier-Kastler E1, Ismail S2, Perrouin-Verbe M1, Rose dit Modestine J2, Denys P3, Phé V1

Research Type

Clinical

Abstract Category

Overactive Bladder

Abstract 689
Non Discussion Abstracts
Scientific Non Discussion Abstract Session 36
Overactive Bladder Neuromodulation Mixed Urinary Incontinence Voiding Dysfunction
1. Médecine Sorbonne Université, 2. Pitié-Salpétrière academic hospital, 3. Université Versailles Saint Quentin
Links

Abstract

Hypothesis / aims of study
Objectives: To assess the long-term functional outcomes of sacral neuromodulation (SNM) in the treatment of refractory idiopathic overactive bladder (IOAB) and to determine predictive factors for success.
Study design, materials and methods
Materials and Methods: To obtain long-term data, all consecutive patients suffering from IOAB and treated by SNM at a single tertiary care center between December 1996 and December 2004 were included. Data regarding patient demographics, past medical, and surgical history, bladder diary, complications as well as device revision and removal rates were collected. Success was defined as an improvement > 50% of any clinical parameter.
Results
Results: Overall, 34 patients, with a median age of 57.8 years (IQR 44.8–65.7) were included. Immediately after definitive implanta- tion, 2 (6%) patients were lost to follow-up. After a median follow-up of 9.7 years (IQR 4.7–12.0), SNM was considered successful in 20 (63%) patients. Mean amount of protections used per 24 hours significantly decreased (4.1 preoperatively vs. 1.8 at the last follow-up visit, p = 0.02). Devices were removed in 2 (6%) patients due to pain and lack of efficacy. Twenty-two revision surgeries were performed in 15 (47%) patients. First revision surgery occurred after a mean of 6.2 years (+/- 3.1). Revision surgeries were mainly performed for end of battery life/device dysfunction (n = 18,82%). No significant predictor for success was identified. Revision-free survival curve for patients implanted with a SNM device is reported on figure 1.
Interpretation of results
The main limitation of this current study may be the small sample size. It is challenging to have a similar long-term follow-up in a larger population. Indeed, European SNM nation-wide registries managed to include more patients, but their follow-ups were shorter (< 5 years) (1). A Canadian group published its 14-year SNM experience (median follow-up of 50.7 months), however the patient cohort was heterogeneous, as it included patients with bladder pain syn- drome, Urge Urinary Incontinence, and idiopathic urinary retention (2).
Concluding message
With a median follow-up time of 9.7 years, our study showed that SNM has a moderate efficacy of 63% (> 50% improvement) as a treatment for refractory IOAB. Moreover, it is a well-tolerated therapy with a relatively low complication rate. We were unable to identify factors predicting for SNM success. SNM is a good treatment option for refractory IOAB as it is minimally invasive and has a respectable long-term outcome. Patients may be informed accordingly.
Figure 1
References
  1. Kessler TM, Buchser E, Meyer S et al. Sacral neuromodulation for refractory lower uri- nary tract dysfunction: results of a nationwide registry in Switzerland. Eur Urol 2007; 51:1357–1363. DOI:10.1016/j.eururo.2006.11.011.
  2. Al-zahrani AA, Elzayat EA, Gajewski JB. Long-term outcome and surgical interven- tions after sacral neuromodulation implant for lower urinary tract symptoms: 14- year experience at 1 center. J Urol 2011;185:981–986. DOI:10.1016/ j.juro.2010.10.054.
Disclosures
<span class="text-strong">Funding</span> Pierre et Marie Curie foundation for its support for the data collection and editing process through the Pitié- Salpétrière urological research account. <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics not Req'd</span> Not necessary at the time of collection of data in the country <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes