Long-term Outcomes of Sacral Nerve Stimulation in Pelvic Floor Dysfunctions

David Hernández-Hernández; Bárbara Padilla-Fernández; Milagros Castro Romera; Stephany Hess Medler; David Castro-Díaz

doi:10.5213/inj.2040364.182

Long-term Outcomes of Sacral Nerve Stimulation in Pelvic Floor Dysfunctions

Int Neurourol J. 2021 Dec;25(4):319-326. doi: 10.5213/inj.2040364.182. Epub 2021 Jan 27.

Authors

David Hernández-Hernández¹, Bárbara Padilla-Fernández^{1

2}, Milagros Castro Romera³, Stephany Hess Medler⁴, David Castro-Díaz^{1

2}

Affiliations

¹ Servicio de Urología, Hospital Universitario de Canarias, Tenerife, Spain.
² Departamento de Cirugía, Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain.
³ Servicio de Cirugía, Hospital Universitario de Canarias, Tenerife, Spain.
⁴ Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad de La Laguna, Tenerife, Spain.

Abstract

Purpose: The aim of this study was to analyze the long-term outcomes of sacral nerve stimulation (SNS) in both idiopathic and neurogenic pelvic floor disorders in patients treated at a referral center.

Methods: This retrospective observational study analyzed the records of 106 patients tested at our department from December 1999 to January 2017. The efficacy variables evaluated were the Global Response Assessment (range, 0%-100%) and, according to the clinical indication, other specific variables such International Consultation on Incontinence QuestionnaireShort Form, number of catheterizations or pads/day, and the numerical pain scale. The safety variables analyzed were complications (pain, migration, infection), reinterventions and explants. Patients' quality of life (QoL) and satisfaction with the procedure were evaluated through telephone interviews.

Results: The clinical indications were overactive bladder (OAB) (n=36), urinary retention (UR) (n=37), bladder pain syndrome/interstitial cystitis (BPS/IC) (n=19), fecal incontinence (FI) (n=8), and double incontinence (DI) (n=6). The implant rates according to the clinical indication were as follows: OAB, 55.6%; UR, 56.8%; BPS/IC, 63.15%; FI, 87.5%; and DI, 66.7%. Clinical and/or statistically significant improvements in all efficacy variables were observed. Loss of therapeutic effect at 75 months of follow-up was observed in 34% of patients. Device-related pain appeared in 25 patients (39%); in 20 patients, it was resolved by reprogramming and 5 patients required device removal. An overall improvement in QoL and high levels of satisfaction with the procedure were observed. More than 90% of patients would recommend SNS to a friend or relative.

Conclusion: SNS is a minimally invasive procedure that offers a real alternative to patients with refractory pelvic floor dysfunction. Its safety profile is very favorable and it provides a long-lasting improvement in symptoms and QoL.

Keywords: Bladder dysfunction; Bladder pain syndrome; Efficacy; Fecal incontinence; Sacral neuromodulation.