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Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation
Author(s) -
Starkman Jonathan S.,
Wolter Christopher E.,
Scarpero Harriette M.,
Milam Douglas F.,
Dmochowski Roger R.
Publication year - 2007
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.20360
Subject(s) - medicine , sacral nerve stimulation , concomitant , neuromodulation , urinary incontinence , overactive bladder , refractory (planetary science) , surgery , urinary retention , urology , physics , alternative medicine , pathology , stimulation , astrobiology
Aims We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (≥80% improvement), moderate response (≥50% and <80% improvement), and poor response (<50% response). Results Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow‐up was 7.2 months. Twenty‐two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow‐up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 ( P < 0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow‐up are needed to assess the durability of this therapeutic modality. Neurourol. Urodynam. © 2006 Wiley‐Liss, Inc.