Functional Rehabilitation of the Neurogenic Bladder by Chronic Sacral Neuromodulation

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Abstract
To assess the value of sacral neuromodulation for treatment of neurogenic bladder dysfunction, 27 patients (19 women, 8 men; mean age 44.9 years) underwent acute and subchronic testing before chronic electrode implantation on a dorsal S3 foramen. Fifteen patients had urgency/frequency owing to detrusor hyperreflexia and/or bladder hypersensitivity, 11 had urinary retention owing to detrusor areflexia, and 1 had combined bladder hypersensitivity and detrusor areflexia. Twelve patients (11 women and 1 man) underwent chronic neurostimulation. Mean follow-up evaluation, by voiding diary and repeated urodynamics, was 17 months (4 - 35 months). Severe side effects were encountered in 2 patients in whom the implant had to be removed (1 with infection, 1 with adverse sensation during stimulation), minor and tolerable side effects in another 3 patients. In 8 patients the urologic sequelae of the neurologic disorder were alleviated significantly (50 % or more), in 5 of them chronic neuromodulation was as effective as preoperative testing. Chronic sacral neuromodulation can be valuable for treating neurogenic bladder dysfunction. However, preoperative evaluation and surgical techniques must be further refined to achieve long-term results that are at least as effective as those of preoperative testing.

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