SACRAL ROOT NEUROMODULATION IN IDIOPATHIC NONOBSTRUCTIVE CHRONIC URINARY RETENTION

Purpose: Sacral root neuromodulation is becoming a superior alternativ e to the standard treatment of idiopathic nonobstructive urinary reten tion. We report results in 20 successive patients who underwent sacral foramen implantation to restore bladder function. Materials and Metho ds: After an initial, thorough baseline assessment 20 patients 19.43 t o 55.66 years old with idiopathic nonobstructive urinary retention und erwent percutaneous nerve evaluation. Response was assessed by a detai led voiding diary. Responders underwent implantation with an S3 forame n implant, and were followed 1, 3 and 6 months postoperatively, and ev ery 6 months thereafter. Results: Sacral root neuromodulation restored voiding capability in these patients. Bladders were emptied with mini mal post-void residual urine, which decreased from 78.3 to 5.5 to 10.2 % of the total voided volume from baseline to postoperative followup. These results were reflected in uroflowmetry and pressure-flow studies , which were almost normal after implantation. Furthermore, the urinar y tract infection rate decreased significantly and associated pelvic p ain improved substantially The Beck depression inventory and SF-36 qua lity of life questionnaire indicated some improvement but reached sign ificance in only 1 item. In addition, cystometrography showed no signi ficant difference after 6 months of implantation compared with baselin e values. Complications were minimal and within expectations. Conclusi ons: Sacral root neuromodulation is an appealing, successful modality for nonobstructive urinary retention. Only patients who have a good re sponse to percutaneous nerve evaluation are candidates for implantatio n. The high efficacy in patients who undergo implantation, relative si mplicity of the procedure and low complication rate make this a treatm ent breakthrough in this difficult group.