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Neuromodulation Essay

1996 words - 8 pages

Purpose: The efficacy of sacral neuromodulation for treating refractory idiopathic lower urinary tract dysfunction is now well established. Nevertheless, results of this technique in neurological patients are still controversial. The aim of this study was to assess the results of sacral neuromodulation in neurogenic bladder dysfunction.
Material and methods: Between 1998 and 2008, a percutaneous nerve evaluation or a two-stage technique was performed in 62 patients (mean age 50.5 ± 14.8 years) with neurogenic lower urinary tract dysfunction. Before and during the temporary stimulation, each patient had an urodynamic evaluation and performed a bladder diary. The test was considered positive if the clinical and urodynamic improvement was over 50% and if the symptoms reappeared after turning the stimulation off.
Results: Lower urinary tract dysfunction was detrusor overactivity in 34 cases and chronic urinary retention in 28 cases. A DSD was associated in nine cases. Out of the 62 patients, 41 patients (66.1%) had more than 50% improvement on urodynamic evaluation and bladder diary and 37 were implanted. With a mean follow-up of 4.3 ± 3.7 years, results remained similar to the evaluation phase in 28 cases (75.7 %), were partially altered in three cases (8.1%) and lost in six cases (16.2%). In these six cases, neuromodulation failed on average 12.0 ± 12.4 months after implantation.
Conclusion: Sacral neuromodulation seems to constitute a serious therapeutic option for patients with neurogenic lower urinary tract dysfunction.

Since 1988 and the work reported by Tanagho and Schmidt, sacral neuromodulation has gradually become a second line treatment for refractory lower urinary tract (LUT) dysfunction [1]. In 2005, at the end of the International Consultation on Incontinence, neuromodulation was even included in the recommendations as a second line treatment for idiopathic and neurogenic detrusor overactivity (DO) [2].
The efficacy of sacral neuromodulation in the treatment of refractory idiopathic LUT dysfunction is now well established [3-6].
In 1996, for the first time, Bosch reported the impact of sacral neuromodulation on detrusor neurogenic LUT dysfunction [7]. Since this time, the results of this technique in neurological patients are still controversial. The results reported diverge and are based on limited numbers [8-12].
The aim of this study was to assess the clinical and urodynamic effects of neuromodulation on patients with neurogenic LUT dysfunction.

Population and Methods
Between 1998 and 2008, 62 patients (47 women and 15 men), mean age 50.5±14.8 years, had a test stimulation for treating neurogenic LUT dysfunction. Neurological diseases are shown in table 1. The mean time between the onset of the underlying neurological disease and the test was 12.7±13.0 years. Bladder dysfunctions were an overactive bladder syndrome in 34 cases (54.8%) including 19 with urge urinary...

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