The use of Sacral Neuromodulation on Urinary and Fecal Incontinence in Iraqi patients

Ismail M1, Al.samak w2

Research Type

Clinical

Abstract Category

Neurourology

Abstract 797
Non Discussion Abstract
Scientific Non Discussion Abstract Session 37
Neuromodulation Anal Incontinence Urgency, Fecal Pelvic Floor Urgency/Frequency
1.college of medicine, university of Baghdad, 2.medical city complex,Baghdad
Links

Abstract

Hypothesis / aims of study
Urinary urge incontinence is characterized by symptoms of frequency, urgency and urge incontinence (either alone or in combination).Urgency frequency syndrome is defined as symptoms of frequency and urgency without incontinence episodes. Fecal incontinence is defined as involuntary passage of stool through the anus. It may vary from soiling to complete evacuation. This involuntary loss of feces, flatus or urge incontinence adversely affects quality of life.
InterStim therapy has been FDAapproved in the US for voiding dysfunction since 1997. Since approval, the therapy has undergone refinement with use of the tined lead  allowing for a minimally invasive approach.
InterStim Therapy is a therapeutic approach for patients with overactive bladder, urinary retention, fecal incontinence and constipation. 

InterStim Therapy uses sacral neuromodulation to modulate the neural reflexes that influence the bladder, the urethral and anal sphincters and the pelvic floor.

Most patients who are eligible for SNM have had complaints for many years, refractory to conservative treatment such as bladder training, pelvic floor exercise, behavioral therapy, and antimuscarinics or a beta-3-adrenergic receptor agonist before SNM is offered. Some patients are refractory even to secondary therapies like botulinum toxin bladder injections or percutaneous tibial nerve stimulation.
aim of the study:
 To evaluate the efficacy and safety of sacral neuromodulation on these pathologies.
Study design, materials and methods
Following a detailed investigation, 27 patients with either urinary incontinence, or both urinary and fecal, who did not respond to medical and behavioral treatment were offered the sacral neuromodulation therapy . patients underwent implantation of the quadripolar tined lead along a sacral nerve root (typically S3) using fluoroscopic guidance.
Motor/sensory responses were confirmed to be considered a successful lead implant. Patients  underwent a 14-day test
stimulation period and were considered a success if  demonstrated either a 50% or more improvement .then perminent device interstim II was implanted and then followed for at least 12 months post  implant regarding response and development of complication if any found
Results
In  the period from novomber 2015 to may 2017 .the unit of neurogenic bladder and neuromodulation in surgical subspeciality hospital, medical city comlex had implanted 27 perminent interstim II devices in 27 patients with bladder overactivity with age ranging from 16 to 61 year old.
17 Patients were  with urgency incontinence (62.96%), 6 Patients were with total incontinence (25.9%),4 Patients were with nocturnal enuresis(14.8%), 9 Patients also had in addition faecal incontinence (33.3%), 8 Patients  also had in addition erectile dysfunction (29.6%), 8 patients were with spinal cord injury (29.6%), 7 Patients were  with myelomeningiocele  (25.9%)
All patients with  uregency incontinence(17) became totaly dry.All patients with total incontinence(6) became totaly dry for at least 3 hours, most of them changed to uegency incontinence.All patients with nocturnal enuresis(4) became totaly dry at night.All patients with urinary retension voided again with no significant post voiding residual.All patients with erectile dysfunction(8) became potent again.All patients with fecal incontinence became totaly continent
Interpretation of results
The mechanism of action of SNM is not well understood and requires further investigation; it seems to involve modulation of spinal cord reflexes and brain networks by peripheral afferents rather than direct stimulation of the motor
response. The intriguing question is how SNM is efficacious for both urinary retention and urgency-frequency syndrome,
as well as fecal incontinence and constipation. The explanation seems to lie in the different underlying pathophysiology
of these disorders . This study showed that patients demonstrates that SNM provides significant objective and subjective relief of symptoms at one-year post implant.
Concluding message
The use of Sacral Neuromodulation in Iraqi patients with  Urinary and Fecal Incontinence is safe and effective
we believe that sacral neuromodulation is a promising procedure for the treatment of fecal and urinary incontinence; it is also used for perineal pain, constipation and urinary retention. With time, a much larger group of pathologies will probably benefit from this procedure.
Disclosures
Funding none Clinical Trial No Subjects Human Ethics Committee college of medicine , university of Baghdad Helsinki Yes Informed Consent Yes