Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction

• DOI: 10.1056/evidoa2200071
• Publication Date: 2022-07-07T16:00:09Z
• Authors: Martina D. Liechti; Stéphanie van der...; Stephanie C. Knüpfer; Dominik Abt; Bernhard Kiss; Lorenz Leitner; Livio Mordasini; Jure Tornic; Jens Wöllner; Ulrich Mehnert; Lucas M. Bachmann; Fiona C. Burkhard; Daniel S. Engeler; Jürgen Pannek; Thomas M. Kessler
• Keywords: Neuromodulation; Sacral nerve stimulation

BACKGROUND: Neurogenic lower urinary tract dysfunction (NLUTD) is a highly prevalent and disabling condition; nevertheless, standard treatments often remain unsatisfactory. Sacral neuromodulation (SNM) well-established therapy for non-NLUTD, but there lack of randomized controlled trials to show benefit in patients with NLUTD. METHODS: For this sham-controlled, double-blind, multicenter trial, refractory NLUTD (and intended SNM) were recruited at four Swiss SNM referral centers. After lead placement into the sacral foramina S3 (rarely, S4), all participants underwent testing. If successful (≥50% improvement key bladder diary variables), neurostimulator was implanted permanent stimulation. 2 months, optimized using subsensory stimulation individually adjusted parameters. Thereafter, remained on or switched off (1:1 random allocation group ON OFF, respectively) followed by neurourologic reevaluation. The primary outcome success, as defined above, compared baseline. RESULTS: Of 124 undergoing testing, 65 (52%) had successfully improved function. these, 60 (median age, 49.5 years; 43 women) randomly assigned intervention. months intervention, demonstrated success rate 76%. In OFF group, 42% showed sustained effects despite their being during last (odds ratio, 4.35; 95% confidence interval, 1.43 13.21; P=0.009). During entire study period, 11 adverse events (6 dropouts; no dropouts intervention phase). CONCLUSIONS: effectively corrected short term well-selected neurologic patients. (Funded National Science Foundation, Vontobel–Stiftung, Gottfried und Julia Bangerter–Rhyner Stiftung, Dr. Urs Mühlebach, Continence Foundation; ClinicalTrials.gov number, NCT02165774.)