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Sacral neuromodulation in diabetic patients: Success and complications in the treatment of voiding dysfunction
Author(s) -
Daniels David H.,
Powell Charles R.,
Braasch Matthew R.,
Kreder Karl J.
Publication year - 2010
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.20791
Subject(s) - medicine , urinary incontinence , urinary retention , diabetes mellitus , surgery , urinary system , sacral nerve stimulation , refractory (planetary science) , cohort , urology , physics , astrobiology , endocrinology
Aims We compared success rates, subsequent complications, and possible indications for success of sacral neuromodulation (SNM) for urinary voiding dysfunction in diabetic and non‐diabetic patients. Methods Thirty‐two diabetic patients (mean age 61.8 years, range 27–83) with urge incontinence, urgency–frequency syndrome, and/or urinary retention refractory to non‐surgical treatment were retrospectively evaluated along with 211 non‐diabetic patients (mean age 54.1 years, range 20–86) with similar symptoms. All patients who experienced ≥50% reduction in urinary symptoms following a 7‐ to 21‐day test period went on to permanent SNM device implantation. Results No significant difference was found with respect to successful conversion rates from the test period to permanent implantation between diabetic and non‐diabetic patients. Long‐term success rates at a mean followup of 29.3 months following permanent device implantation for diabetic patients were 69.2% of those with urge incontinence, 85.7% of those with urgency–frequency, and 66.7% of those with urinary retention. The non‐diabetic cohort had success rates of 67.0% for urge incontinence, 67.8% for urgency/frequency, and 58.2% for urinary retention ( P = 0.823, 0.157, and 0.631, respectively). No patient experienced intraoperative complications. Nine of 24 (37.5%) devices were explanted postoperatively in diabetic patients compared with 36 of 141 (25.5%) in non‐diabetic patients ( P = 0.224). The number of explants due to infection was higher in diabetic patients (16.7%) versus non‐diabetic patients (4.3%; P = 0.018). Conclusions No difference in long‐term success rates was seen in diabetic patients when compared with similar, non‐diabetic patients. Diabetic patients did, however, have a higher incidence of device explantation due to infection. Neurourol. Urodynam. © 2009 Wiley‐Liss, Inc.