CLINICAL-RESULTS OF SACRAL NEUROMODULATION FOR CHRONIC VOIDING DYSFUNCTION USING UNILATERAL SACRAL FORAMEN ELECTRODES

The aim of this study was to determine the long-term clinical efficacy and complications of neuromodulation with a unilateral sacral foramen electrode in 36 patients with chronic voiding dysfunction. Following a positive effect of a percutaneous nerve evaluation test? patients un derwent open surgery. A permanent electrode was implanted in 24 patien ts with urge incontinence, in 6 with urgency-frequency syndrome, and i n 6 with nonobstructive urinary retention. After an average followup p eriod of 37.8 months, 19 patients (52.8%) continue to benefit from the neuromodulation with a significant improvement of symptoms and urodyn amic parameters. The median duration of the therapeutic effect for the total study population was longer than 60 months. No significant diff erence in the median duration of therapeutic effect with regard to sex , the type of voiding disorder, or the implant pulse generator was fou nd. However, in patients with previous psychological disorders the med ian duration of therapeutic effect was only 12 months (P = 0.008). Com plications were mild. In the group of patients in whom the therapeutic effect remains, 37 reoperations have had to be performed. We conclude that although reoperations were needed to overcome technical problems , patients can achieve lasting symptomatic improvement. Since technica l changes in the equipment have reduced the number of complications, e ven better results can be expected in terms of the reoperation rate.