Sacral neuromodulation for women with Fowler's syndrome

Neuromodulation of the sacral nerves has been found to be an effective ther apy for a variety of lower urinary tract dysfunctions. The reported success rate for the period of trial stimulation (peripheral nerve evaluation test ) prior to permanent implantation of a sacral nerve stimulator is variable, but generally reported to be in the region of 30-50%. We present here the results of the peripheral nerve evaluation test in 38 patients with urinary retention. 34 of the 38 had been found to have an abnormality of their str iated urethral sphincter on electromyography using a concentric needle elec trode, i.e., they had the disorder which was described by Fowler and cowork ers in 1988. The overall success rate in this group was 68%. We believe tha t our relatively high success rate is due to sacral neuromodulation working via a mechanism which involves the urethral sphincter, an abnormality whic h had been demonstrated in 89% of these patients. Twelve of the patients su bsequently underwent permanent implantation of a sacral nerve stimulator, a nd all of them have experienced a return of voiding. However, in 2 patients , there is a persisting need for self-catherization. There is, however, a h igh reoperation rate. Copyright (C) 2000 S. Karger AG, Basel.