The Effect of Sacral Neuromodulation (SNM) on Nocturia

Knie R1, Marcelissen T2, Martens F3, Voegeli T1, Rahnama'i M1

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 766
Non Discussion Abstract
Scientific Non Discussion Abstract Session 37
Nocturia Female Neuromodulation Overactive Bladder
1.University Hospital RWTH Aachen, Germany, 2.Maastricht University Medical VEnter, The Netherlands, 3.Radboud University Medical Center Nijmegen, The Netherlands
Links

Abstract

Hypothesis / aims of study
Sacral neuromodulation is an accepted treatment option for patients with idiopathic OAB or chronic nonobstructive urinary retention that is refractory to conservative treatment. [1] Since Food and Drug Administration approval in 1997 an increasing number of patients have been treated with SNM.
Nocturia, defined as nocturnal micturition with a frequency of at least once per night, is one of the most frequent lower urinary tract symptoms and often causes them to consult a physician. Nocturia is often bothersome and responsible for increased morbidity and mortality. In this study, we aimed to assess the effect of Sacral Neuro Modulation (SNM) during Percutaneous Nerve Evaluation (PNE) test on Nocturia
Study design, materials and methods
Patients received an Medtronic intestim device after showing a successful response to PNE or first stage tined lead screening tests. Success was defined as more than 50% improvement in at least 1 of the relevant voiding diary parameters compared to baseline. For OAB wet cases these parameters included a reduction in daily episodes of incontinence or pad use, and for OAB dry cases a reduction in the number of daily voids or an increase in voided volume per void.
Before the start of the protocol all patients completed a 3-day voiding diary to evaluate the effect of unilateral stimulation, which served as baseline measurement. PNE test was done to evaluate the effect of contralateral and bilateral stimulation. The stimulation electrode was placed in the contralateral S3 foramen. Sensory and motor responses were used to ensure correct lead positioning. The lead position that provoked an adequate response at the lowest possible amplitude was chosen to ensure that the lead was in close proximity to the nerve root. X-ray was done to verify lead position.
After implantation patients visited the outpatient clinic after 6 weeks, 6 months and yearly thereafter. In cases of decreased efficacy the impedance and battery life span were checked. Parameter settings were adjusted to restore efficacy. In cases of permanent loss of efficacy electrode position and cable integrity were checked using fluoroscopy.
We evaluated micturition diaries of 41 female patients who underwent a PNE test for the treatment of their Overactive bladder syndrome. Of these 41 patients, 40 had nocturia, defined as a micturition episode of one or more per night. Only patients suffering from nocturia were included in the study. Bladder diaries were kept for three days before and three days during the PNE test.
Results
Nocturia improved in in 25 patients (62.5%), with 19 patients (47.5%) reporting a reduction of one or more visits per night (an average of 3.9 to 2.1). Furthermore 6 patients reported a reduction of 0.5 times per night (an average of 3 to 2.5). In 9 patients there was no change of nocturia episodes (average 2.3 times per night). On the other hand, in 6 cases, there was a deterioration of bladder function at night with 0.5 times more visits to the toilet per night (from 2.1 to 2.6 times per night), in two cases (5%) even once more per night (on average 4.5 to 5.5 times per night). (Table 1)
Interpretation of results
A  reduction of nocturia occured in about 2/3 of all patients ondergoing a PNE test for OAB. In about 1/4 of all patients there was no change of nocturia episodes. Furthermore, in 6 cases, there was a non clinically significant  deterioration of bladder function at night with 0.5 times more visits to the toilet per night (from 2.1 to 2.6 times per night), and in two cases (5%) a significant deterioration of one more nocturia episode per night  occured.
Concluding message
SNM has a positive effect on nocturia during the PNE test. In about 62 % of patients nocturia episodes improved significantly. The long term effects of SNM on nocturia need to be evaluated in a prospective trial with a larger sample size.
Figure 1
References
  1. Marcelissen TA1, Leong RK, de Bie RA, van Kerrebroeck PE, de Wachter SG. Long-term results of sacral neuromodulation with the tined lead procedure J Urol. 2010 Nov;184(5):1997-2000. doi: 10.1016/j.juro.2010.06.142. Epub 2010 Sep 18.
Disclosures
Funding none Clinical Trial No Subjects Human Ethics Committee MUMC Helsinki Yes Informed Consent Yes