To study the response of Sacral Neuromodulation in patients with voiding dysfunctions.

In this retrospective chart analysis, we evaluated all patients receiving Sacral Neuro Modulation device for Voiding Dysfunction and Non Obstructive Urinary Retention at our unit form January 2016 till December 2020. Patients were screened with detail voiding questioner, voiding diary reviews and necessary clinical examination if needed.  All the patients underwent UDS and screening for renal function and any urinary infection.
	
	All the procedures were performed by a single surgeon, having a sub-specialty, fellowship in NEUR0-UROLOGY, using tined lead implants, InterStim II (MEDTRONICS, USA) device was used in all cases. 
	All patients underwent a two staged procedure, a 1st stage Test Stimulation and  then followed by  2nd stage Permanent Implantation, if they had a >50% symptoms improvement. Those who qualified for successful second stage permanent SNM implantation were followed over two years with a three month follow at first year, then every six month at second year. 
	The demographic details of the studied patients well explained in in table 1.

In our study group we had a total of 28 patients 11 male and 17 female. They indications to undergo SNM therapy was as overactive bladder 1(4%), urge incontinence 4(14%), Urinary Incontinence 5(18%) and Idiopathic urinary retention 18(64%) as shown in chart 1.
	The data was analyzed using Fischer test for Statistical analysis. Out of these 28 cases, 12(42.85%) patients has failed response following test stimulation, 3(10.71%) had no response on test stimulation, so test electrodes were immediately removed, while 9(32.14%) had positive response at the testing  time, but latter on had poor response so get removed over time as shown in table 3. While 15(57.15%) patients after positive response on at first stage, underwent successful second stage permanent SNM device implantation. Of this one patient got lost in follow up for waiting to undergo second stage permanent device implantation. The waiting periods between two stages were 10-28 days.
Over the two years all those who underwent second stage permanent implantation were followed at 3 month, 6, 12, 18 and 24 month. At each visit all were reviewed for symptoms relief, by going through their voiding diary any other complaints related to procedure. During this period 3(18.75%) has explanation of the SNM device, in 1(3.57%) patient because of occurrence of implantation site infections and in 2(7.14%) patients due to device malfunctioning, despite reprogramming.

The response rate in overactive bladder was none, while in Urge Incontinence 50%, Urinary Incontinence 60% and urinary retention 50%. The p value on analysis was 0.99, statistically not significant.

Sacral Neuromodulation is safe and effective therapy for voiding dysfunctions in adults.

Peeters K, Sahai A, De Ridder D, et al. Long term follow up of sacral neuromodulation for lower urinary tract dysfunction. BJU Int 2014; 113:789-94
Jairam R, Drossaerts, Vrijiens D, et al. Affective symptoms and quality of life in patients with void or storage dysfunctions: results before and after sacral neuromodulation: A prospective follow up study. Neurourol Urodyn 2018; 37: 1801-8.
Noblett K, Berg KV, Kan F, et al. Baseline symptom severity and therapeutics success in a large prospective trial of sacral neuro modulation therapy for overactive bladder patients. Neurourol Urodyn 2018; 37: 1667-71.