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SACRAL NERVE
STIMULATION - WHO BENEFITS FROM A BILATERAL APPROACH ?
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Authors:
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D.-H. Zermann, H. Wunderlich,
O. Reichelt, J. Schubert, R.A. Schmidt
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Institution:
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Department of Urology,
University Hospital, Friedrich-Schiller-University Jena, Germany;
University of Colorado, Denver, CO, USA
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Aims of
the Study:
Unilateral sacral nerve stimulation is an accepted therapeutic option in the
treatment of chronic urinary retention, urge incontinence and chronic pelvic
pain. Published success rates vary between 64 and 75%. The neurophysiological
background of the clinical success is still an unknown. Further clinical developments
should focus on the improvement of success rates, i.e., by introducing bilateral
sacral nerve stimulation.
Methods:
A standard neurourological work-up, a percutaneous nerve evaluation and a temporary
uni- and bilateral sacral nerve stimulation were carried out in 81 patients.
Mean duration of temporary stimulation was 8.4 days. The therapeutic success
was evaluated using history, micturition/ pain diary, cystometry, uroflowmetry
and post void residual volume.
Results:
65 patients (80.2 %) were tested successfully. 71.6 % of all patients benefits
from a unilateral stimulation only. However, 8.6 % needed a bilateral stimulation
for therapy success. Looking in detail we found the following improvement rates
comparing uni- and bilateral temporary sacral nerve stimulation:
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1. chronic urinary retention
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80.6 % ® 86.2 %
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2. urge incontinence
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42.1 % ® 63.2 %
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3. chronic pelvic pain
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80.8 % ® 84.6 %.
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19.2% of all patients
did not respond on sacral nerve stimulation.
Conclusions:
Patients with urge incontinence benefit most from a bilateral approach. 21.1
% of all patients suffering from urge were significantly improved during bilateral
sacral nerve stimulation. For patients suffering on urinary retention and chronic
pelvic pain a bilateral sacral nerve stimulation does not reveal a significant
advantage. Because of the immense cost factor all patients should be screened
primarily for the effect of unilateral sacral nerve stimulation. In case of
failure a bilateral approach should be considered.