Sacral Neuromodulation for Urinary Retention

Table 1.

Main Studies of Sacral Neuromodulation for Urinary Retention

Box 1.

Causes of Urinary Retention

Tanagho EA and Schmidt RA (1982) Bladder pacemaker: scientific basis and clinical future. Urology 20: 614-619
Hassouna MM et al. (2000) Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. J Urol 163: 1849-1854
Siegel SW et al. (2000) Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgencyfrequency, and retention. Urology 56: 87-91
Bosch JL and Groen J (2000) Sacral nerve neuromodulation in the treatment of patients with refractory motor urge incontinence: long-term results of a prospective longitudinal study. J Urol 163: 1219-1222
Jonas U et al. (2001) Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol 165: 15-19
Kessler TM et al. (2007) Sacral neuromodulation for refractory lower urinary tract dysfunction: results of a nationwide registry in Switzerland. Eur Urol 51: 1357-1363
van Kerrebroeck PE et al. (2007) Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol 178: 2029-2034
Takeda M et al. (2003) Diagnosis and treatment of voiding symptoms. Urology 62: 11-19
Fowler CJ et al. (1988) Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome? BMJ 297: 1436-1438
Abrams P et al. (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21: 167-178
De Ridder D et al. (2007) The presence of Fowler's syndrome predicts successful long-term outcome of sacral nerve stimulation in women with urinary retention. Eur Urol 51: 229-233; discussion 233-234
Spinelli M and Sievert KD (2008) Latest technologic and surgical developments in using InterStim™ therapy for sacral neuromodulation: impact on treatment success and safety. Eur Urol [doi:10.1016/ j.eururo.2008.01.076]
Janknegt RA et al. (1997) Improving neuromodulation technique for refractory voiding dysfunctions: two-stage implant. Urology 49: 358-362
Hohenfellner M et al. (1998) Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction. J Urol 160: 821-824
Braun PM et al. (1999) Tailored laminectomy: a new technique for neuromodulator implantation. J Urol 162: 1607-1609
Spinelli M et al. (2003) New percutaneous technique of sacral nerve stimulation has high initial success rate: preliminary results. Eur Urol 43: 70-74
Spinelli M et al. (2003) New sacral neuromodulation lead for percutaneous implantation using local anesthesia: description and first experience. J Urol 170: 1905-1907
Scheepens WA et al. (2001) Buttock placement of the implantable pulse generator: a new implantation technique for sacral neuromodulation-a multicenter study. Eur Urol 40: 434-438
Sievert KD et al. (2007) Permanente sakrale Neuromodulation mittels InterStim®: Ergebnisse einer Anwenderbefragung zu aktuellen technischen Entwicklungen. J Urol Urogynäkol 4: 14-16
Swinn MJ et al. (2000) Sacral neuromodulation for women with Fowler's syndrome. Eur Urol 38: 439-443
Aboseif S et al. (2002) Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction. Urology 60: 52-56
Bross S et al. (2003) The role of the carbachol test and concomitant diseases in patients with nonobstructive urinary retention undergoing sacral neuromodulation. World J Urol 20: 346-349
Datta SN et al. (2008) Sacral neurostimulation for urinary retention: 10-year experience from one UK centre. BJU Int 101: 192-196
Sievert KD et al. (2007) Subcutaneous tunneling of the temporary testing electrode significantly improves the success rate of subchronic sacral nerve modulation (SNM). World J Urol 25: 607-612
Scheepens WA et al. (2002) Long-term efficacy and safety results of the two-stage implantation technique in sacral neuromodulation. BJU Int 90: 840-845
Malaguti S et al. (2003) Neurophysiological evidence may predict the outcome of sacral neuromodulation. J Urol 170: 2323-2326
Goh M and Diokno AC (2007) Sacral neuromodulation for nonobstructive urinary retention-is success predictable? J Urol 178: 197-199
Borawski KM et al. (2007) Predicting implantation with a neuromodulator using two different test stimulation techniques: a prospective randomized study in urge incontinent women. Neurourol Urodyn 26: 14-18
Kessler TM et al. (2005) Prolonged sacral neuromodulation testing using permanent leads: a more reliable patient selection method? Eur Urol 47: 660-665
Kessler TM et al. (2008) Safety of prolonged sacral neuromodulation tined lead testing. Curr Med Res Opin 24: 343-347
Everaert K et al. (2004) A prospective randomized trial comparing the 1-stage with the 2-stage implantation of a pulse generator in patients with pelvic floor dysfunction selected for sacral nerve stimulation. Eur Urol 45: 649-654
van Voskuilen AC et al. (2006) Long term results of neuromodulation by sacral nerve stimulation for lower urinary tract symptoms: a retrospective single center study. Eur Urol 49: 366-372
White WM et al. (2008) Sacral nerve stimulation for treatment of refractory urinary retention: long-term efficacy and durability. Urology 71: 71-74
Elhilali MM et al. (2005) Sacral neuromodulation: longterm experience of one center. Urology 65: 1114-1117
Shaker HS and Hassouna M (1998) Sacral root neuromodulation in idiopathic nonobstructive chronic urinary retention. J Urol 159: 1476-1478
Aboseif S et al. (2002) Sacral neuromodulation in functional urinary retention: an effective way to restore voiding. BJU Int 90: 662-665
Das AK et al. (2004) Improvement in depression and health-related quality of life after sacral nerve stimulation therapy for treatment of voiding dysfunction. Urology 64: 62-68
Aboseif SR et al. (2007) Sacral neuromodulation: cost considerations and clinical benefits. Urology 70: 1069-1073
Swinn MJ et al. (1999) Leg pain after sacral neuromodulation: anatomical considerations. BJU Int 84: 1113-1115
Spinelli M et al. (2001) Chronic sacral neuromodulation in patients with lower urinary tract symptoms: results from a national register. J Urol 166: 541-545
Hijaz A et al. (2006) Complications and troubleshooting of two-stage sacral neuromodulation therapy: a single-institution experience. Urology 68: 533-637
Brazzelli M et al. (2006) Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. J Urol 175: 835-841
Van Voskuilen AC et al. (2007) Medium-term experience of sacral neuromodulation by tined lead implantation. BJU Int 99: 107-110
Dindo D et al. (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240: 205-213
Everaert K et al. (2000) Patient satisfaction and complications following sacral nerve stimulation for urinary retention, urge incontinence and perineal pain: a multicenter evaluation. Int Urogynecol J Pelvic Floor Dysfunct 11: 231-235
Sutherland SE et al. (2007) Sacral nerve stimulation for voiding dysfunction: one institution's 11-year experience. Neurourol Urodyn 26: 19-28
Deng DY et al. (2006) Failure of sacral nerve stimulation due to migration of tined lead. J Urol 175: 2182-2185
Kessler TM et al. (2005) Bilateral migration of sacral neuromodulation tined leads in a thin patient. J Urol 173: 153-154
Spinelli M et al. (2005) New tined lead electrode in sacral neuromodulation: experience from a multicentre European study. World J Urol 23: 225-229
Scheepens WA et al. (2002) Unilateral versus bilateral sacral neuromodulation in patients with chronic voiding dysfunction. J Urol 168: 2046-2050
Maher MG et al. (2007) Bilateral caudal epidural neuromodulation for refractory urinary retention: a salvage procedure. J Urol 177: 2237-2240
Fowler CJ et al. (2000) Studies of the latency of pelvic floor contraction during peripheral nerve evaluation show that the muscle response is reflexly mediated. J Urol 163: 881-883
Schurch B et al. (2003) Electrophysiological recordings during the peripheral nerve evaluation (PNE) test in complete spinal cord injury patients. World J Urol 20: 319-322
van der Pal F et al. (2006) Current opinion on the working mechanisms of neuromodulation in the treatment of lower urinary tract dysfunction. Curr Opin Urol 16: 261-267
Riazimand SH and Mense S et al. (2004) A rat model for studying effects of sacral neuromodulation on the contractile activity of a chronically inflamed bladder. BJU Int 94: 158-163
Riazimand SH and Mense S (2005) Interaction between neurotransmitter antagonists and effects of sacral neuromodulation in rats with chronically hyperactive bladder. BJU Int 96: 900-908
Minardi D et al. (2008) Activity and expression of nitric oxide synthase in rat bladder after sacral neuromodulation. Int J Immunopathol Pharmacol 21: 129-135
Wang Y and Hassouna MM (2000) Neuromodulation reduces c-fos gene expression in spinalized rats: a double-blind randomized study. J Urol 163: 1966-1970
Shaker H et al. (2000) Role of C-afferent fibres in the mechanism of action of sacral nerve root neuromodulation in chronic spinal cord injury. BJU Int 85: 905-910
Zhou Y et al. (2002) Change of vanilloid receptor 1 following neuromodulation in rats with spinal cord injury. J Surg Res 107: 140-144
Wang Y et al. (2000) Neuromodulation reduces urinary frequency in rats with hydrochloric acid-induced cystitis. BJU Int 86: 726-730
Groen J et al. (2006) Sacral neuromodulation in women with idiopathic detrusor overactivity incontinence: decreased overactivity but unchanged bladder contraction strength and urethral resistance during voiding. J Urol 175: 1005-1009
Sievert KD et al. (2008) The early implantation of bilaterally sacral nerve modulators to prevent the neurogenic bladder malfunction in paraplegic patients [abstract 574]. Eur Urol Suppl 7: 214
Blok BF et al. (2006) Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators. BJU Int 98: 1238-1243
Leng WW and Chancellor MB (2005) How sacral nerve stimulation neuromodulation works. Urol Clin North Am 32: 11-18
DasGupta R and Fowler CJ (2004) Urodynamic study of women in urinary retention treated with sacral neuromodulation. J Urol 171: 1161-1164
Dasgupta R et al. (2005) Changes in brain activity following sacral neuromodulation for urinary retention. J Urol 174: 2268-2272
Schultz-Lampel D et al. (1998) Experimental results on mechanisms of action of electrical neuromodulation in chronic urinary retention. World J Urol 16: 301-304
Bannowsky A et al. (2003) Sacral neuromodulation in treatment of functional disorders of the lower urinary tract. An overview of basic principles, indications, outcomes [German]. Urologe A 42: 1357-1365
Wyndaele JJ et al. (2000) Influence of sacral neuromodulation on electrosensation of the lower urinary tract. J Urol 163: 221-224
Braun PM et al. (2002) Alterations of cortical electrical activity in patients with sacral neuromodulator. Eur Urol 41: 562-566
Tai C et al. (2006) Pudendal-to-bladder reflex in chronic spinal-cord-injured cats. Exp Neurol 197: 225-234
Vitton V et al. (2008) Colonosphincteric electromyographic responses to sacral root stimulation: evidence for a somatosympathetic reflex. Neurogastroenterol Motil 20: 407-416
Chai TC et al. (2000) Percutaneous sacral third nerve root neurostimulation improves symptoms and normalizes urinary HB-EGF levels and antiproliferative activity in patients with interstitial cystitis. Urology 55: 643-646
Gooneratne ML et al. (2008) Normalization of substance P levels in rectal mucosa of patients with faecal incontinence treated successfully by sacral nerve stimulation. Br J Surg 95: 477-83

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Author(s)

Thomas M. Kessler, MD

Clinical and Research Fellow, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom

Disclosures

Disclosure: Thomas M. Kessler, MD, has disclosed that he has served as a consultant for Medtronic, Inc.

Clare J. Fowler, FRCP

Consultant; Professor of Uro-Neurology; Head of the Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom

Disclosures

Disclosure: Clare J. Fowler, FRCP, has disclosed that she has served as a consultant for Medtronic, Inc.

Editor(s)

Nayanah Siva

Locum Editor, Nature Clinical Practice Urology

Disclosures

Disclosure: Nayanah Siva has disclosed no relevant financial relationships.

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Summary and Introduction

Summary

Urinary retention without an identifiable urological cause presents a diagnostic and therapeutic challenge. Patients with nonobstructive chronic urinary retention usually have to rely on intermittent self-catheterization or indwelling suprapubic or transurethral catheters, which significantly affect quality of life. For some patients, however, sacral neuromodulation (SNM) offers an effective therapeutic alternative, and women with primary disorder of urethral sphincter relaxation (Fowler's syndrome) seem to respond particularly well to this treatment. Although the mechanism of action of SNM is not well understood and requires further investigation, it seems to involve afferent mediation of spinal cord reflexes and brain networks. The evolution of SNM devices and improvements in surgical and testing techniques, especially the introduction of the two-stage tined lead procedure, have considerably reduced the failure, adverse event and surgical revision rates associated with SNM, ensuring that this modality is an effective minimally invasive treatment for urinary retention.

Introduction

Sacral neuromodulation (SNM) was developed in the early 1980s by Tanagho and Schmidt,^[1] and has become a well-established treatment modality for patients with refractory lower urinary tract dysfunction, such as nonobstructive chronic urinary retention, urgency–frequency syndrome and urgency incontinence.^[1-7] SNM uses a continuous or cycling mode of electrical pulses to activate or inhibit neural reflexes associated with lower urinary tract function via stimulation of the sacral nerves, which innervate the lower urinary tract and pelvic floor. This article reviews the technological developments, outcomes, and mechanism of action of SNM therapy, focusing on its use in patients with urinary retention.