SACRAL NERVE ROOT NEUROMODULATION - AN EFFECTIVE TREATMENT FOR REFRACTORY URGE INCONTINENCE

Purpose: Sacral foramina implants have been recognized recently as a m ethod for treatment of refractory urinary urge incontinence. We study the outcome of the procedure with in-depth analysis of the results of 18 implanted cases. Materials and Methods: Patients with urinary urge incontinence were subjected to percutaneous nerve evaluation of the S3 roots as a temporary screening test to determine response to neuromod ulation. Satisfactory responders were implanted with permanent sacral root neuroprosthesis. The study design included comprehensive voiding diaries for 4 consecutive days twice as a baseline, 1 with percutaneou s nerve evaluation screening, 1 after the percutaneous nerve evaluatio n, 1 at the 1, 3 and 6 post-implantation visits, and every 6 months th ereafter. Uroflowmetry and quality of life questionnaires were perform ed at the same intervals. Urodynamic study was done as a baseline and 6 months after implantation of the neuroprosthesis. Results: All 18 pa tients (16 women and 2 men) with refractory urge incontinence received a sacral foramina neuroprosthesis after demonstrating a good response to the percutaneous nerve evaluation. Average patient age at presenta tion was 42.3 +/- 3.3 years (range 22 to 67) and duration of urinary s ymptoms was 6.6 +/- 1.3 years (range 1.2 to 18.8). Average followup wa s 18.8 months (range 3 to 83). Neuromodulation in these patients showe d a marked reduction in leakage episodes from 6.49 to 1.98 times per 2 4 hours and in the leakage severity score. Eight patients became compl etely dry and 4 had average leakage episodes of 1 or less daily. Patie nts showed as well a decrease in urinary frequency with an increase in functional bladder capacity. Associated pelvic pain improved substant ially. Cystometrograms demonstrated increased volume at first sensatio n by 50% and increased cystometric capacity by 15% with the disappeara nce of uninhibited contractions in 1 of the 4 patients who presented w ith it preoperatively. There was also noticeable improvement in the qu ality of life. Complication rate was low and none was life threatening . Conclusions: Sacral root neuromodulation is an appealing modality fo r treatment of urge incontinence refractory to conventional pharmacoth erapy. The relative simplicity of the technique, promising results and low complication rate make this therapy a likely alternative.