Vol. 42 (2): 312-320, March – April, 2016
Initial experience with sacral neuromodulation for the treatment of lower urinary tract dysfunction in Brazil
Luis Augusto Seabra Rios 1, Marcio Augusto Averbeck 2, Wagner França 3, Carlos Alberto Ricetto Sacomani 4, Fernando G. Almeida 3, Cristiano Mendes Gomes 5
1 Deparamento de Urologia, Hospital Albert Einstein, SP, Brasil; 2 Departamento de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil; 3 Universidade Federal de São Paulo, Escola Paulista de Medicina, SP, Brasil; 4 Departamento de Urologia, AC Camargo Hospital, SP, Brasil; 5 Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
Objectives: We report on the short-term outcomes of sacral neuromodulation (SNM) for treatment of idiopathic lower urinary tract dysfunction in Brazil (procedures performed before 2014).
Materials and Methods: Clinical data and surgical outcomes of patients who underwent SNM staged procedures were retrospective evaluated. Urological assessment included a focused medical history and physical examination, measurement of postvoid residual volumes, urodynamics, and bladder diaries. A successful test phase has been defined by improvement of at least 50% of the symptoms, based on bladder diaries.
Results: From January 2011 to December 2013, eighteen consecutive patients underwent test phase for SNM due to refractory overactive bladder (15 patients), non-obstructive chronic urinary retention (2 patients), and bladder pain syndrome/interstitial cystitis (1 patient). All patients underwent staged procedures at four outpatient surgical centers.
Mean age was 48.3±21.2 (range 10-84 years). There were 16 women and 2 men. Median follow-up was 3 months. Fifteen patients (83.3%) had a successful test phase and underwent implantation of the pulse generator (IPG). Median duration of the test phase was 7 days (range 5–24 days). Mean age was 45.6±18.19 years in responders versus 61.66±34.44 years in non-responders (p=0.242). Mean operative time (test phase) was 99±33.12 min in responders versus 95±35 min for non-responders (p=0.852). No severe complications were reported.
Conclusion: SNM is a minimally invasive treatment option for patients with refractory idiopathic lower urinary tract dysfunction. Our initial experience with staged technique showed that tined-lead electrodes yielded a high rate of responders and favorable clinical results in the short-term follow-up.
Keywords: Sacrum; Urinary Tract; Therapeutics