Feasibility of Sacral Neuromodulation in Patients With Underlying Neurologic Lower Urinary Tract Dysfunction and Fecal Incontinence

Purpose

To evaluate the efficacy and safety of sacral neuromodulation (SNM) in patients with underlying neurologic conditions and compare outcomes to non-neurogenic patients.

Methods

Between 2017-2022 patients undergoing 2-staged implantation of InterStim™ II were included in a single-center retrospective study. Patients were allocated into two groups: underlying neurologic conditions (Group1) or non-neurogenic (Group2). Efficacy and safety were evaluated by comparing patients' bladder/bowel logs pre- and post-operative. Patients' demographics, indications, pre-implantation urodynamic study (UDS) variables, surgery duration, number of post-op visits, and time to revision/removal procedures were compared and included in the data analysis.

Results

67 patients (64.2% female) with a mean age of 63.23±14.15 years were included in the study – 16/67(23.9%) patients assigned to Group 1. There is no statistically significant difference between the groups regarding the indication for the treatment. The most common indication was non-obstructing urinary retention (NOUR) in both study groups. The common neurologic pathologies were multiple sclerosis, disc disease, and spinal stenosis. Overall and sub-group (based on an indication for SNM implantation) analyses showed no significant difference in patients' demographics, the surgery duration, or the chances for clinical success with a similar follow-up period. During the follow-up, the device was removed in 4 (25.0%) and 10 (19.6%) of the patients in Group 1 and Group 2, respectively (p=0.912). There was no significant difference between the groups in the time till InterStim™ II removal (p=0.905). All NOUR patients with clinical success in Group 1 had an improvement of at least 75% from the baseline compared to 69% of patients in Group 2 (p=0.42). Univariate analysis in NOUR patients demonstrated that maximal cystometric capacity below 430 mL and the presence of detrusor contraction at voiding were statistically significant predictors of successful SNM. Overall, at the end of the follow-up period, 8 (50.0%) and 29 (56.9%) patients in Groups 1 and 2, respectively, were defined as clinical success (p=0.775).