Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Jonathan S. Starkman, Christopher E. Wolter, Harriette M. Scarpero, Douglas F. Milam, Roger R. Dmochowski

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Aims: We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods: A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (≥80% improvement), moderate response (≥50% and <80% improvement), and poor response (<50% response). Results: Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion: Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality.

Original languageEnglish (US)
Pages (from-to)29-35
Number of pages7
JournalNeurourology and Urodynamics
Volume26
Issue number1
DOIs
StatePublished - 2007
Externally publishedYes

Fingerprint

Urge Urinary Incontinence
Vesicovaginal Fistula
Urinary Bladder Neck Obstruction
Urodynamics
Prolapse
Suspensions
Therapeutics
Prospective Studies

Keywords

  • Bladder
  • Urethra
  • Urinary incontinence
  • Vagina

ASJC Scopus subject areas

  • Clinical Neurology
  • Nephrology
  • Urology

Cite this

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation. / Starkman, Jonathan S.; Wolter, Christopher E.; Scarpero, Harriette M.; Milam, Douglas F.; Dmochowski, Roger R.

In: Neurourology and Urodynamics, Vol. 26, No. 1, 2007, p. 29-35.

Research output: Contribution to journalArticle

Starkman, Jonathan S. ; Wolter, Christopher E. ; Scarpero, Harriette M. ; Milam, Douglas F. ; Dmochowski, Roger R. / Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation. In: Neurourology and Urodynamics. 2007 ; Vol. 26, No. 1. pp. 29-35.
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abstract = "Aims: We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods: A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (≥80{\%} improvement), moderate response (≥50{\%} and <80{\%} improvement), and poor response (<50{\%} response). Results: Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88{\%}) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50{\%} improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion: Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality.",
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