WESTPORT, CT (Reuters Health) Nov 22 - Sacral nerve stimulation is a minimally invasive, safe and effective alternative to bladder augmentation for patients with spinal cord disease-related urinary incontinence that fails to respond to conventional treatment.
"Because sacral neuromodulation therapy is nondestructive and does not compromise the potential for future treatment, it appears to be a promising therapy for neurogenic incontinence," Dr. Emmanuel J. Chartier-Kastler, of the University of Pierre et Marie Curie, in Paris, France, and a multinational team conclude in the November issue of the Journal of Urology.
The researchers examined the benefits of sacral nerve stimulation in nine women with various spinal cord disorders. All had chronic urinary incontinence due to detrusor hyperreflexia that had failed to respond to parasympatholytic drugs.
The treatment consisted of surgically implanting a sacral lead connected to a subcutaneous stimulator. The pulse amplitude was adjusted for each patient until stimulation was sensed or pelvic floor muscles responded. All nine patients had a positive response in a stimulation trial conducted prior to implantation.
During a mean follow-up period of 43.6 months, "all patients had clinically significant improvement of incontinence and five were completely dry," the investigators report.
Significant improvements in urodynamic parameters, including maximum bladder capacity and volume at first uninhibited contraction, were observed 6 months after implantation, and returned to baseline when stimulation was discontinued. Maximum detrusor pressure at first uninhibited contraction also changed in most patients, increasing in three, stabilizing in two and decreasing in four. To date, none of the patients has required bladder augmentation.
Dr. Chartier-Kastler and colleagues point out that sacral nerve stimulation has the advantages of being simple to perform, potentially curative, and safe, as well as relatively inexpensive if the life of the neurostimulator battery exceeds 5 years.
J Urol 2000;164:1476-1480.
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