MP17-10 SACRAL NEUROMODULATION THERAPY IN PATIENTS WITH NEUROLOGIC LOWER URINARY TRACT DYSFUNCTION – SHOULD IT REMAIN AN OFF LABEL INDICATION? ANALYSIS OF 80 CONSECUTIVE CASES

Sacral neuromodulation for neurological disease-induced lower urinary tract symptoms in Saudi Arabia: a single-centre experience

Objective

To evaluate the effectiveness of sacral neuromodulation therapy (SNM) for lower urinary tract symptoms (LUTS) caused by neurological diseases.

Methods

This prospective cohort study enrolled patients that developed LUTS secondary to neurological disorders. All patients underwent staged SNM. A 5-day voiding diary was used to evaluate their response to the stage 1 procedure. Implantation of the full system during the stage 2 procedure was undertaken in patients that had ≥50% improvement on their voiding diary.

Results

Twenty-one patients were included in the study with the following neurological aetiologies: diabetes mellitus (n = 2), myelitis (n = 3), multiple sclerosis (n = 5), spinal cord injury (n = 10) and cerebrovascular accident (n = 1). Fifteen patients underwent the stage 1 procedure successfully; their mean age was 47.5 years and the mean follow-up was 29 months. SNM resulted in significantly increased voided volume/void/day, decreased leaking episodes/day, decreased postvoiding residual/day and decreased number of clean intermittent catheterization/day compared with baseline. Five patients were highly satisfied, nine were moderately satisfied and one patient was not satisfied with the therapy.

Conclusion

SNM was an effective therapy for LUTS caused by neurological disease and there was a high rate of patient satisfaction.

Is there a role for sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction?

PURPOSE

To review current literature regarding sacral neuromodulation (SNM) for neurogenic lower urinary tract dysfunction (NLUTD) focused on indications, barriers and latest technological developments.

MATERIAL AND METHODS

A PubMed database search was performed in April 2020, focusing on SNM and various neuro-urological conditions.

RESULTS

SNM has been increasingly indicated for lower urinary tract dysfunction (LUTD) in neuro-urological patients. Most studies are cases series with several methodological limitations and limited follow-up, lacking standardized definition for SNM clinical success. Most series focused on neurogenic overactive bladder in spinal cord injured (incomplete lesions) and multiple sclerosis patients. Barriers for applying this therapy in neurogenic LUTD were mainly related to magnetic resonance imaging incompatibility, size of the implantable pulse generator (IPG), and battery depletion. Newer technological advances have been made to address these limitations and will be widely available in the near future.

CONCLUSIONS

SNM seems a promising therapy for neurogenic LUTD in carefully selected patients with incomplete lesions. Further studies are still needed to define which subgroups of neurological patients benefit the most from this minimally invasive technique.

Management of neurogenic bladder in patients with Parkinson's disease: A systematic review

AIMS

To assess the different treatment methods in management of neurogenic bladder (NGB) in patients with Parkinson's disease (PD).

METHODS

A systematic search was performed in Cochrane library, EMBASE, Proquest, Clinicaltrial.gov, WHO, Google Scholar, MEDLINE via PubMed, Ovid, ongoing trials registers, and conference proceedings in November 11, 2017. All randomized controlled trials (RCTs) or quasi-RCTs comparing any treatment method for management of NGB in patients with PD were included. The titles and abstracts of all identified studies were evaluated independently by two investigators. Once all of the potential related articles were retrieved, each author separately evaluated the full text of each article and the quality of the methodology of the selected studies using the Cochrane appraisal risk of bias checklist and then the data about the patient's outcomes was extracted. We registered the title in Joanna Briggs Institute (JBI) that is available in http://joannabriggs.org/research/registered_titles.aspx.

RESULTS

We included 41 RCTs or quasi-RCTs or three observational study with a total of 1063 patients that evaluated pharmacological, neurosurgical, botulinum toxin, electrical neuromodulation, and behavioral therapy effects on NGB. Among the included studies only solifenacin succinate double-blind, randomized, placebo-controlled study was assessed as low risk of bias, and treatment led to an improvement in urinary incontinence.

CONCLUSIONS

Although several interventions are available for treatment NGB in patients with PD, at present there is little or no evidence that treatment improves patient outcomes in this population. Additional large, well designed, randomized studies with improved methodology and reporting focused on patient-centered outcomes are needed.