van_kerrebroeck_2pages.qxp 27/7/07 05:07 Page 89
Sacral Nerve Stimulation for Neuromodulation of the Lower Urinary Tract
Clinical Results and Complications of Sacral described the complications seen at their institute,
51
reporting 10.5%
Nerve Stimulation explantations and 16.1% revisions because of a decrease in clinical
In 1999 a prospective, randomised study was published that presents the response. Gaynor-Krupnick presented an algorithm for the evaluation
results in UI.
43
Hassouna et al. reported in 2000 on the treatment of UF and management of a malfunctioning neuromodulation system.
52,53
symptoms.
44
A report on their use in urinary retention was published in
2001 by Jonas.
45
The first long-term follow-up results of the above Expanding Indications
mentioned patient series were published in 2000.
28
After two years of Improvements with SNS were published for off-label applications such as
follow-up, 56% of the UF patients showed a greater than 50% reduction interstitial cystitis (IC), chronic pelvic pain, paediatric voiding dysfunction
in voids per day. In the retention group, 70% of 42 patients showed a and neurogenic lower urinary dysfunction. In 2000 the first papers were
greater than 50% reduction in catheter volume per catheterisation. published with positive results in IC.
54,55
Comiter evaluated the effect for
Recently, the five-year follow-up results were analysed. At five years, IC in a prospective study in 2003.
56
Over the years, some patients
68% of UI, 56% of UF and 71% of retention patients had successful presented with SNS for chronic pelvic or genito-urinary pain.
57
SNS
outcomes. An important finding in this study is the high correlation therapy is also evaluated in bowel dysfunction.
58–60
Jarrett reviewed faecal
between the one- and five-year success rates. Of the implanted patients, incontinence and constipation.
61
The results seem promising. SNS therapy
84% with UI, 71% with UF and 78% with retention continued to have a in children with neurogenic bladder dysfunction is described by Guys.
62
successful outcome at five-year follow-up if successful at one year.
46
Different clinics have published long-term results.
47–49
They all concluded Sexuality
that SNS is a safe and effective therapy. Patients may report improved sexual functioning after implant. Pauls
reported on the effects of SNS on sexual function.
63
With SNS, sexual
Many studies report on complications of SNS. Siegel summarised the frequency and female sexual function index (FSFI) increased significantly.
complications in patients, which were included in the original trials.
28
Of
the vast majority of complications, 11.8% were related to lead migration. Conclusions
Technical problems and pain represented 2.6 and 2.1%, respectively. In After years of experimental therapy, SNS is a widely used therapy.
patients with a permanent system in place, 15.3% had pain at Although the mechanism for this therapy is not fully understood, it has
neurostimulator site, 9% had pain, 8.4% had suspected lead migration, been proved effective for the long term. Due to its less invasive
5.5% had transient electric shock, 5.4% had pain at lead site and 3% technique and technical improvements it is expected that complication
had adverse change in bowel function. Surgical revisions were performed rates will decrease over the coming years. The expanding use of SNS
in 33.3%. Recently, our long-term follow-up results with complication therapy in other fields will probably result in FDA approval. Research
rates were published.
47
Most events could be solved by giving advice or with the help of animal models will allow us to understand the
by reprogramming the stimulator. In our experience with the tined lead mechanisms of SNS therapy, and allow effective patient selection with
implantation we see a clear decrease in re-operation rate.
50
Hijaz et al. even better results. ■
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