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John A Coller - One of the best experts on this subject based on the ideXlab platform.
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long term durability of Sacral Nerve Stimulation therapy for chronic fecal incontinence
Diseases of The Colon & Rectum, 2013Co-Authors: Tracy Hull, Chad Giese, Steven D Wexner, Anders F Mellgren, Ghislain Devroede, Robert D Madoff, Katherine Stromberg, John A CollerAbstract:BACKGROUND: Limited data have been published regarding the long-term results of Sacral Nerve Stimulation, or Sacral neuromodulation, for severe fecal incontinence. OBJECTIVES: The aim was to assess the outcome of Sacral Nerve Stimulation with the use of precise tools and data collection, focusing on the long-term durability of the therapy. Five-year data were analyzed. DESIGN: Patients entered in a multicenter, prospective study for fecal incontinence were followed at 3, 6, and 12 months and annually after device implantation. PATIENTS: Patients with chronic fecal incontinence in whom conservative treatments had failed or who were not candidates for more conservative treatments were selected. INTERVENTIONS: Patients with ≥ 50% improvement over baseline in fecal incontinence episodes per week during a 14-day test Stimulation period received Sacral Nerve Stimulation therapy. MAIN OUTCOME MEASURES: Patients were assessed with a 14-day bowel diary and Fecal Incontinence Quality of Life and Fecal Incontinence Severity Index questionnaires. Therapeutic success was defined as ≥ 50% improvement over baseline in fecal incontinence episodes per week. All adverse events were collected. RESULTS: A total of 120 patients (110 women; mean age, 60.5 years) underwent implantation. Seventy-six of these patients (63%) were followed a minimum of 5 years (maximum, longer than 8 years) and are the basis for this report. Fecal incontinence episodes per week decreased from a mean of 9.1 at baseline to 1.7 at 5 years, with 89% (n = 64/72) having ≥ 50% improvement (p < 0.0001) and 36% (n = 26/72) having complete continence. Fecal Incontinence Quality of Life scores also significantly improved for all 4 scales between baseline and 5 years (n = 70; p < 0.0001). Twenty-seven of the 76 (35.5%) patients required a device revision, replacement, or explant. CONCLUSIONS: The therapeutic effect and improved quality of life for fecal incontinence is maintained 5 years after Sacral Nerve Stimulation implantation and beyond. Device revision, replacement, or explant rate was acceptable, but future efforts should be aimed at improvement.
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long term durability of Sacral Nerve Stimulation therapy for chronic fecal incontinence
Diseases of The Colon & Rectum, 2013Co-Authors: Tracy L Hull, Chad Giese, Steven D Wexner, Anders F Mellgren, Ghislain Devroede, Robert D Madoff, Katherine Stromberg, John A CollerAbstract:BACKGROUND:Limited data have been published regarding the long-term results of Sacral Nerve Stimulation, or Sacral neuromodulation, for severe fecal incontinence.OBJECTIVES:The aim was to assess the outcome of Sacral Nerve Stimulation with the use of precise tools and data collection, focusing on th
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Sacral Nerve Stimulation for fecal incontinence results of a 120 patient prospective multicenter study
Annals of Surgery, 2010Co-Authors: Steven D Wexner, Ghislain Devroede, John A Coller, Tracy L Hull, Richard W Mccallum, Miranda Chan, Jennifer M Ayscue, Abbas Shobeiri, David A Margolin, Michael EnglandAbstract:Background:Sacral Nerve Stimulation has been approved for use in treating urinary incontinence in the United States since 1997, and in Europe for both urinary and fecal incontinence (FI) since 1994. The purpose of this study was to determine the safety and efficacy of Sacral Nerve Stimulation in a l
Seth A Alpert - One of the best experts on this subject based on the ideXlab platform.
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comparison of antegrade continence enema treatment and Sacral Nerve Stimulation for children with severe functional constipation and fecal incontinence
Neurogastroenterology and Motility, 2020Co-Authors: Marc A Levitt, Mana H Vriesman, Lyon Wang, Candice Park, Karen A Diefenbach, Richard J Wood, Seth A AlpertAbstract:BACKGROUND To compare antegrade continence enema (ACE) treatment and Sacral Nerve Stimulation (SNS) in children with intractable functional constipation (FC) and fecal incontinence (FI). METHODS We performed a retrospective review of children 6-18 years old with FC and FI treated with either ACE or SNS at our institution. We recorded symptoms at baseline, 6 months, 12 months, 24 months, and their most recent visit after starting treatment. We compared improvement in FI, bowel movement (BM) frequency, abdominal pain, laxative use, and complications. Patients were contacted to evaluate perceived benefit using the Glasgow Children's Benefit Inventory. KEY RESULTS We included 23 patients treated with ACE (52% female, median age 10 years) and 19 patients treated with SNS (74% female, median age 10 years). Improvement in FI was greater with SNS than ACE at 12 months (92.9% vs 57.1%, P = .03) and 24 months (100% vs 57.1%, P = .02). Improvement in BM frequency was greater with ACE, and children were more likely to discontinue laxatives at all follow-up time points (all P < .05). Improvement in abdominal pain was greater with ACE at the most recent visit (P < .05). Rate of complications requiring surgery was similar between groups (26.3% vs 21.7%). Benefit was reported in 83.3% and 100% of ACE and SNS groups, respectively (NS). CONCLUSIONS AND INFERENCES Although both ACE and SNS can lead to durable improvement in children with FC and FI, SNS appears more effective for FI and ACE more effective in improving BM frequency and abdominal pain and in discontinuation of laxatives.
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Sacral Nerve Stimulation allows for decreased antegrade continence enema use in children with severe constipation
Journal of Pediatric Surgery, 2017Co-Authors: Lindsey Asti, Peter C Minneci, Katherine J Deans, Steven Teich, Seth A Alpert, Daniel L Lodwick, Kristine M Nacion, Desale Yacob, Carlo Di Lorenzo, Hayat MousaAbstract:Abstract Background Sacral Nerve Stimulation (SNS) can be beneficial for children with constipation, but no studies have focused on children with constipation severe enough to require antegrade continence enemas (ACEs). Our objective was to evaluate the efficacy of SNS in children with constipation treated with ACE. Methods Using a prospective patient registry, we identified patients Results Twenty-two patients (55% male, median 12years) were included. Median ACE frequency decreased from 7 per week at baseline to 1 per week at 12months ( p p =0.02). Six (27%) children experienced complications after SNS that required further surgery. Conclusions In children with severe constipation dependent on ACE, SNS led to a steady decrease in ACE usage with nearly half of patients receiving cecostomy/appendicostomy closure within 2years. Level of evidence IV.
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Sacral Nerve Stimulation for pediatric lower urinary tract dysfunction development of a standardized pathway with objective urodynamic outcomes
The Journal of Urology, 2015Co-Authors: Megan S Schober, Jason P Sulkowski, Peter C Minneci, Katherine J Deans, Steven Teich, Seth A AlpertAbstract:Purpose: We propose that Sacral Nerve Stimulation is a valid adjunctive therapy for refractory pediatric lower urinary tract dysfunction, and that prospective collection of preoperative and postoperative validated questionnaires and urodynamic data in a standardized fashion is beneficial in characterizing patient response.Materials and Methods: Patients were candidates for Sacral Nerve Stimulation if they had refractory voiding dysfunction and standard treatments had failed. Preoperative evaluation included urodynamic studies, spinal magnetic resonance imaging, and validated bladder and bowel related questionnaires. Children were stratified into 2 groups, ie overactive bladder with or without incontinence (group 1) and detrusor underactivity/urinary retention requiring clean intermittent catheterization (group 2). A staged procedure was used with initial test lead placement, followed by permanent device insertion 2 weeks later if patients demonstrated symptom improvement with test lead. Postoperatively ch...
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Sacral Nerve Stimulation a promising therapy for fecal and urinary incontinence and constipation in children
Journal of Pediatric Surgery, 2015Co-Authors: Jason P Sulkowski, Peter C Minneci, Katherine J Deans, Seth A Alpert, Kristine M Nacion, Hayat Mousa, Marc A Levitt, Steven TeichAbstract:Abstract Purpose This study describes our series of children with bowel and bladder dysfunction (BDD) treated with Sacral Nerve Stimulation in order to begin to identify characteristics associated with better outcomes and guide future therapies. Methods Between May 2012 and February 2014, 29 patients were evaluated before and after Sacral Nerve stimulator (SNS) placement. A prospective data registry was developed that contains clinical information and patient-reported measures: Fecal Incontinence Qualify of Life Scale, Fecal Incontinence Severity Scale, PedsQL Gastrointestinal Symptom Scale, and Vancouver DES Symptom Scale. Results The median age of patients was 12.1 (interquartile range: 9.4, 14.3) years and the median follow-up period was 17.7 (12.9, 36.4) weeks. 93% had GI complaints and 65.5% had urinary symptoms while 7% had urologic symptoms only. The most common etiologies of BBD were idiopathic (66%) and imperforate anus (27%). Five patients required reoperation due to a complication with battery placement. Six of 11 patients (55%) with a pre-SNS cecostomy tube no longer require an antegrade bowel regimen as they now have voluntary bowel movements. Ten of eleven patients (91%) no longer require anticholinergic medications for bladder overactivity after receiving SNS. Significant improvements have been demonstrated in all four patient-reported instruments for the overall cohort. Conclusions Early results have demonstrated improvements in both GI and urinary function after SNS placement in pediatric patients with bowel and bladder dysfunction.
C J Vaizey - One of the best experts on this subject based on the ideXlab platform.
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Sacral Nerve Stimulation for faecal incontinence secondary to congenital imperforate anus
Techniques in Coloproctology, 2013Co-Authors: G P Thomas, R J Nicholls, C J VaizeyAbstract:After treatment in infancy, patients with imperforate anus can develop bowel dysfunction in adult life. Low anorectal malformations are often associated with congenital deformity of the sacrum and coccyx (sacrococcygeal agenesis). Sacral Nerve Stimulation (SNS) is an effective treatment for incontinent patients with an accompanying acquired sphincter defect. We report two patients treated by SNS for faecal incontinence secondary to congenital imperforate anus. Two adults presented with faecal incontinence. Both had a congenital imperforate anus. The first, a female 36 years old, suffered from lifelong incontinence. She had daily passive soiling, a sensation of incomplete emptying and urgency (less than 5 min). The second, a male 35 years old, had had incontinence since adulthood. He had urgency (2 min) and daily soiling. Both had undergone coloanal pull-through procedures in infancy. Anal manometry showed a low resting pressure in both patients (30 and 33 cm H2O) and a reduced peak squeeze pressure increment (15 and 40 cm H2O). Endoanal ultrasonography demonstrated a complete ring of muscle around the neo-anus in both patients. The patients underwent peripheral Nerve evaluation (PNE). Both had partial Sacral agenesis, which made this technically difficult. After 3 weeks of PNE, the female patient showed no improvement, but the male patient had no further episodes of incontinence and urgency improved from 2 to 15 min. Accordingly, he underwent implantation of a permanent pulse generator. SNS may be effective for some incontinent patients with imperforate anus even in the presence of partial Sacral agenesis. The clinician should be aware of any associated Sacral agenesis and the technical difficulty this may cause. Alternative methods of neuromodulation, such as pudendal Nerve Stimulation, could be considered in such cases.
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Sacral Nerve Stimulation for faecal incontinence patient selection service provision and operative technique
Colorectal Disease, 2011Co-Authors: Thomas C Dudding, R J Nicholls, J R Hollingshead, C J VaizeyAbstract:Aim Faecal incontinence is estimated to affect between 2 and 3% of Western adult populations. In recent years Sacral Nerve Stimulation has become an important treatment modality, often as the first-line surgical therapy. The aim of this article was to review the current evidence regarding patient selection and surgical technique and to evaluate the logistics of providing a neuroStimulation service. Method A Medline search was performed including the keywords and/or MeSH headings of Sacral Nerve Stimulation, neuromodulation, artificial pacemaker, faecal incontinence, patient selection, predictive factors and anal canal. Further studies were identified by cross-referencing from relevant articles and by appraisal of recent peer-reviewed conference abstracts and proceedings. Results Despite the success of Sacral Nerve Stimulation for several pathophysiological causes of incontinence, case selection is of paramount importance. Sacral Nerve Stimulation should not be offered outside a multidisciplinary pelvic floor unit. Temporary evaluation using diary cards can lead to false positive and negative results. Adherence to a meticulous surgical technique, using low amplitude Stimulation to guide lead placement, provides optimal clinical outcome. Conclusion The short-term outcome of Sacral Nerve Stimulation is dependent on patient factors and operative technique. Despite this, specific preoperative predictive factors of treatment success have yet to be identified.
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Sacral Nerve Stimulation for intractable constipation
Gut, 2010Co-Authors: Michael A Kamm, Soren Laurberg, Jarno Melenhorst, Zengri Wang, Steen Buntzen, Claes Johansson, T C Dudding, M E D Jarrett, H R Rosen, C J VaizeyAbstract:Objective Traditional surgical procedures for intractable idiopathic constipation are associated with a variable outcome and substantial morbidity. The symptomatic response, physiological effect and effect on quality of life of Sacral Nerve Stimulation (SNS) were evaluated in patients with constipation (slow transit and normal transit with impaired evacuation). Methods In a prospective study at five European sites patients who failed conservative treatment underwent 21 days test Stimulation. Patients with >50% improvement in symptoms underwent permanent neurostimulator implantation. Primary end points were increased defecation frequency, decreased straining and decreased sensation of incomplete evacuation. Results 62 patients (55 female, median age 40 years) underwent test Stimulation, of whom 45 (73%) proceeded to chronic Stimulation. 39 (87%) of these 45 patients achieved treatment success. After a median 28 (range 1e55) months follow-up, defecation frequency increased from 2.3 to 6.6 evacuations per week (p<0.001). Days per week with evacuation increased from 2.3 to 4.8 (p<0.001). There was a decrease in time spent toileting (10.5 to 5.7 min, p¼0.001), straining (75e46% of successful evacuations, p<0.001), perception of incomplete evacuation (71.5e46% of successful evacuations, p<0.001) and subjective rating of abdominal pain and bloating (p<0.001). Cleveland Clinic constipation score (0¼no to 30¼severe constipation) decreased from 18 to 10 (p<0.001). Visual analogue scale (VAS) score (0¼severe to 100¼no symptoms) increased from 8 to 66 (p<0.001). Patients with slow and normal transit benefited. Quality of life significantly improved. Colonic transit normalised in half of those with baseline slow transit (p¼0.014). Conclusion SNS is effective in the treatment of idiopathic slow and normal transit constipation resistant to conservative treatment. Clinical Trial Number NCT00200005.
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Sacral Nerve Stimulation for the treatment of faecal incontinence related to dysfunction of the internal anal sphincter
International Journal of Colorectal Disease, 2010Co-Authors: Thomas C Dudding, C J Vaizey, David Pares, Michael A KammAbstract:Purpose In patients with faecal incontinence related to isolated internal anal sphincter (IAS) disruption, conservative management is the mainstay of treatment. Surgical repair of the internal sphincter is not successful. This study evaluated the use of Sacral Nerve Stimulation (SNS) in those with faecal incontinence and IAS disruption in whom medical and behavioural treatments had failed.
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predictive factors for successful Sacral Nerve Stimulation in the treatment of faecal incontinence a 10 year cohort analysis
Colorectal Disease, 2008Co-Authors: T C Dudding, C J Vaizey, David Pares, Michael A KammAbstract:Objective Sacral Nerve Stimulation (SNS) is an established treatment for faecal incontinence. We aimed to identify specific factors that could predict the outcome of temporary and permanent Stimulation. Method A cohort analysis was performed to identify potential predictive factors in 81 patients who underwent temporary SNS at a single institution over a 10-year period (June 1996 to June 2006). Data were obtained from prospectively collected patient symptom diaries and quality of life questionnaires, operation reports, anorectal physiological studies, endoanal ultrasound images and radiology of lead placement. Results Clinical outcome of temporary screening was not affected by patient gender, age, body mass index, severity or length of symptoms. The need for a repeated temporary procedure was associated with subsequent failure during screening (P = 0.008). A low threshold to obtain a motor response during temporary lead insertion was associated with improved outcome (P = 0.048). Evidence of anal sphincter trauma was associated with a greater risk of failure (P = 0.040). However, there was no difference in medium-term outcome between patients with external anal sphincter (EAS) defects and patients with intact anal sphincter muscles. Conclusion Variables have been identified that help to predict the outcome of SNS. The presence of an EAS defect should not preclude treatment.
Michael A Kamm - One of the best experts on this subject based on the ideXlab platform.
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constipation Sacral Nerve Stimulation for intractable References Sacral Nerve Stimulation for intractable constipation
2020Co-Authors: Michael A Kamm, Soren Laurberg, Thomas C Dudding, Jarno Melenhorst, Michael Jarrett, Zengri Wang, Steen Buntzen, Claes Johansson, Harald Rosen, Carolynne J VaizeyAbstract:ABSTRACT Objective Traditional surgical procedures for intractable idiopathic constipation are associated with a variable outcome and substantial morbidity. The symptomatic response, physiological effect and effect on quality of life of Sacral Nerve Stimulation (SNS) were evaluated in patients with constipation (slow transit and normal transit with impaired evacuation). Methods In a prospective study at five European sites patients who failed conservative treatment underwent 21 days test Stimulation. Patients with >50% improvement in symptoms underwent permanent neurostimulator implantation. Primary end points were increased defecation frequency, decreased straining and decreased sensation of incomplete evacuation
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Sacral Nerve Stimulation for intractable constipation
Gut, 2010Co-Authors: Michael A Kamm, Soren Laurberg, Jarno Melenhorst, Zengri Wang, Steen Buntzen, Claes Johansson, T C Dudding, M E D Jarrett, H R Rosen, C J VaizeyAbstract:Objective Traditional surgical procedures for intractable idiopathic constipation are associated with a variable outcome and substantial morbidity. The symptomatic response, physiological effect and effect on quality of life of Sacral Nerve Stimulation (SNS) were evaluated in patients with constipation (slow transit and normal transit with impaired evacuation). Methods In a prospective study at five European sites patients who failed conservative treatment underwent 21 days test Stimulation. Patients with >50% improvement in symptoms underwent permanent neurostimulator implantation. Primary end points were increased defecation frequency, decreased straining and decreased sensation of incomplete evacuation. Results 62 patients (55 female, median age 40 years) underwent test Stimulation, of whom 45 (73%) proceeded to chronic Stimulation. 39 (87%) of these 45 patients achieved treatment success. After a median 28 (range 1e55) months follow-up, defecation frequency increased from 2.3 to 6.6 evacuations per week (p<0.001). Days per week with evacuation increased from 2.3 to 4.8 (p<0.001). There was a decrease in time spent toileting (10.5 to 5.7 min, p¼0.001), straining (75e46% of successful evacuations, p<0.001), perception of incomplete evacuation (71.5e46% of successful evacuations, p<0.001) and subjective rating of abdominal pain and bloating (p<0.001). Cleveland Clinic constipation score (0¼no to 30¼severe constipation) decreased from 18 to 10 (p<0.001). Visual analogue scale (VAS) score (0¼severe to 100¼no symptoms) increased from 8 to 66 (p<0.001). Patients with slow and normal transit benefited. Quality of life significantly improved. Colonic transit normalised in half of those with baseline slow transit (p¼0.014). Conclusion SNS is effective in the treatment of idiopathic slow and normal transit constipation resistant to conservative treatment. Clinical Trial Number NCT00200005.
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Sacral Nerve Stimulation for the treatment of faecal incontinence related to dysfunction of the internal anal sphincter
International Journal of Colorectal Disease, 2010Co-Authors: Thomas C Dudding, C J Vaizey, David Pares, Michael A KammAbstract:Purpose In patients with faecal incontinence related to isolated internal anal sphincter (IAS) disruption, conservative management is the mainstay of treatment. Surgical repair of the internal sphincter is not successful. This study evaluated the use of Sacral Nerve Stimulation (SNS) in those with faecal incontinence and IAS disruption in whom medical and behavioural treatments had failed.
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predictive factors for successful Sacral Nerve Stimulation in the treatment of faecal incontinence a 10 year cohort analysis
Colorectal Disease, 2008Co-Authors: T C Dudding, C J Vaizey, David Pares, Michael A KammAbstract:Objective Sacral Nerve Stimulation (SNS) is an established treatment for faecal incontinence. We aimed to identify specific factors that could predict the outcome of temporary and permanent Stimulation. Method A cohort analysis was performed to identify potential predictive factors in 81 patients who underwent temporary SNS at a single institution over a 10-year period (June 1996 to June 2006). Data were obtained from prospectively collected patient symptom diaries and quality of life questionnaires, operation reports, anorectal physiological studies, endoanal ultrasound images and radiology of lead placement. Results Clinical outcome of temporary screening was not affected by patient gender, age, body mass index, severity or length of symptoms. The need for a repeated temporary procedure was associated with subsequent failure during screening (P = 0.008). A low threshold to obtain a motor response during temporary lead insertion was associated with improved outcome (P = 0.048). Evidence of anal sphincter trauma was associated with a greater risk of failure (P = 0.040). However, there was no difference in medium-term outcome between patients with external anal sphincter (EAS) defects and patients with intact anal sphincter muscles. Conclusion Variables have been identified that help to predict the outcome of SNS. The presence of an EAS defect should not preclude treatment.
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systematic review of Sacral Nerve Stimulation for faecal incontinence and constipation
British Journal of Surgery, 2004Co-Authors: M E D Jarrett, R J Nicholls, Cynthia Fraser, G Mowatt, Cathryn Glazener, Adrian Grant, Michael A KammAbstract:Background and method: This systematic review assesses the efficacy and safety of Sacral Nerve Stimulation (SNS) for faecal incontinence and constipation. Electronic databases and selected websites were searched for studies evaluating SNS in the treatment of faecal incontinence or constipation. Primary outcome measures included episodes of faecal incontinence per week (faecal incontinence studies) and number of evacuations per week (constipation studies). Results: From 106 potentially relevant reports, six patient series and one crossover study of SNS for faecal incontinence, and four patient series and one crossover study of SNS for constipation, were included. After implantation, 41–75 per cent of patients achieved complete faecal continence and 75–100 per cent experienced improvement in episodes of incontinence. There were 19 adverse events among 149 patients. The small crossover study reported increased episodes of faecal incontinence when the implanted pulse generator was switched off. Case series of SNS for constipation reported an increased frequency of evacuation. There were four adverse events among the 20 patients with a permanent implant. The small crossover study reported a reduced number of evacuations when the pulse generator was switched off. Conclusion: SNS results in significant improvement in faecal incontinence in patients resistant to conservative treatment. Early data also suggest benefit in the treatment of constipation. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Philip Van Kerrebroeck - One of the best experts on this subject based on the ideXlab platform.
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Sacral Nerve Stimulation for neuromodulation of the lower urinary tract
Neurourology and Urodynamics, 2008Co-Authors: Dennis Oerlemans, Philip Van KerrebroeckAbstract:Patients with symptoms of overactive bladder syndrome or non-obstructive urinary retention, refractory to conservative therapy, can nowadays be treated minimally invasively with Sacral Nerve Stimulation (SNS). The use of electric currents to treat urological pathology has a long history but SNS therapy only received FDA approval in 1997. The mechanisms of action are still not known so there are different theories explaining the modulation effect. Recent studies have shown a central modulation effect. Predictive factors which can help to identify the perfect candidates are not known. Over the years the technique of SNS has become less invasive and because of two stage implantation test results have proven to be more reliable. The clinical results for this therapy have proven to be safe and effective and with the technical improvements over the years the re-operation and complication rates have decreased significantly. The clinical results have led to expanding indications because of positive effects in other symptoms. In the field of urology this has resulted in the use of SNS therapy for interstitial cystitis, neurogenic lower urinary dysfunction, and pediatric voiding dysfunction. In the field of gastro-intestinal pathology, SNS therapy is used to treat faecal incontinence and constipation.
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long term results of neuromodulation by Sacral Nerve Stimulation for lower urinary tract symptoms a retrospective single center study
European Urology, 2006Co-Authors: A C Van Voskuilen, Dennis Oerlemans, E H J Weil, R A De Bie, Philip Van KerrebroeckAbstract:Abstract Objective To analyse the influence of technical improvements of Sacral Nerve Stimulation (SNS) on the incidence of surgical interventions and subjective long-term results of SNS. Methods Retrospective, transversal study analyzing records of implanted patients at our department of Urology. Results Of 149 patients analyzed, 107 had overactive bladder symptoms and 42 had urinary retention. Mean follow-up was 64,2 (sd=38,5) months. In the whole group 194 adverse events occurred. 6 Patients had infection in their implanted system, one was explanted for infection. Most events could be solved by giving advice or by reprogramming the stimulator. 129 reoperations have been performed and 21 patients had their system explanted. Analysis of the data shows a striking difference in the incidence of reoperations, but small differences in subjective results in the groups of patients implanted before or after 1996, suggesting that a proactive approach towards adverse events is worthwhile. Conclusions SNS gives lasting benefit in patients with refractory symptoms of overactive bladder and non-obstructive urinary retention. The differences in outcomes and incidence of reoperation can be attributed to the learning curve and technical and surgical improvements in the application of SNS.
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Sacral Nerve Stimulation for treatment of refractory urinary urge incontinence
The Journal of Urology, 1999Co-Authors: Richard A Schmidt, Udo Jonas, Kimberly Oleson, R A Janknegt, Magdy M Hassouna, Steven W Siegel, Philip Van KerrebroeckAbstract:AbstractPurpose: A prospective, randomized study was performed to evaluate Sacral Nerve Stimulation for the treatment of refractory urinary urge incontinence.Materials and Methods: Primary outcome variables were obtained from voiding diaries. After baseline evaluation candidates who satisfied inclusion criteria were enrolled into the study. Test Stimulation results determined eligibility for randomization into a Stimulation (treatment) or delay (control) group. The Stimulation group included 34 patients who underwent implantation and were followed for 6 months. The delay group comprised 42 patients who received standard medical therapy for 6 months and then were offered implantation. The Stimulation group completed a therapy evaluation test (on versus off) after 6 months.Results: At 6 months the number of daily incontinence episodes, severity of episodes and absorbent pads or diapers replaced daily due to incontinence were significantly reduced in the Stimulation compared to the delay group (all p <0.0001...
