| Objectives: This study aimed to report sacral neuromodulation (SNM)
outcomes in detrusor underactivity (DU).
Methods: A multicentric, multinational, retrospective case series was conducted
between March 2017 and June 2021 in three different referral centers. Initial test
phase stimulation included either a percutaneous nerve evaluation (PNE) or an
advanced lead evaluation test phase (ALTP) before permanent SNM implantation.
The test phases were performed under local anesthesia, either in the outpatient
(PNE) or operating room (ALTP), in the prone position, which was implanted in
the third or fourth sacral foramina under fluoroscopic guidance. Patients with
favorable response to the initial test phase during the first 2 weeks underwent the
implantable pulse generator (IPG) implantation (Medtronic neurostimulation
generator device InterStim™). Favorable response was defined as ≥ 50% improvement in symptoms, frequency of clean intermittent catheterization (CIC) and/
or decrease in postvoid residual (PVR), increase in voided volume, or improvement
in bladder voiding efficiency (BVE) based on the bladder diary.
Results: Fifty‐eight patients were recruited with a mean age of 39.95 ± 15.28 years.
Among the 58 cases, 36 (62.1%) patients responded to the initial stage. Of these,
12 patients (30.8%) with non‐neurogenic etiology and nine patients (52.9%) with
neurologic etiology did not respond to the initial test phase; thus, they did not
undergo full implantation (p = 0.141). Voided volume, PVR, and the median
maximum flow rate (Qmax) improved significantly (p < 0.001) in both sexes;
however, there was no statistical difference between both genders. Most female
cases (78.3%), and nearly half of the men (51.4%), responded to the test phase and
were candidates for the IPG phase. Among the 35 cases who underwent IPG,
27 patients (72.2% of males, and 77.8% of females; p = 0.700) had a favorable
response to IPG. 46.6% of patients had a successful outcome at the end of the study.
Conclusion: This multicentric study showed that SNM effectively and safely
provided symptom improvement in refractory DU in males similar to females
which is an important finding as previously it has been suggested that SNM
works better in nonobstructive urinary retention in women and not in women. |