Sacral neuromodulation in urological indications: The Finnish experience

Abstract

Objective. Sacral neuromodulation is a treatment modality for voiding dysfunction that is resistant to conventional medical and surgical treatments. In Finland, sacral neuromodulation has been used for the treatment of urgency–frequency syndrome, non-obstructive urinary retention and painful bladder/interstitial cystitis since 1996. Material and methods. The investigation retrospectively evaluated 180 tested patients, 74 of whom underwent permanent implantation of the InterStim device. Results. A positive test result leading to implantation was significantly more frequent among females than males. Among urinary retention patients, the patients with a positive test leading to implantation were significantly younger than those without implantation. The implantation operation time was significantly shorter when using a tined lead device compared with open electrode insertion (76 vs 122 min). The mean follow-up time was 41 months (range 0–143). Significant improvement after implantation was noted in the mean urinated volumes and number of daily urinations, as well as in the number of catheterizations in urgency–frequency syndrome and urinary retention, respectively. The subjective long-term outcome was similar in these indications. Surgical revision was required for 15 patients (20.3% of implanted patients). Conclusions. The difference in gender distribution compared with earlier published series may be explained by a selection bias due to the limited referrals of female patients from gynaecologists. The results favour the use of a tined lead device because of the shorter operating room time. Furthermore, the outcome seems to be more favourable among patients with a staged implant procedure compared with a one-stage operation with a tined lead device.

Key Words::

• Outcome
• painful bladder
• retrospective chart review
• urgency–frequency syndrome
• urinary retention

Acknowledgements

We are grateful to Mrs Kaisa Heinola and Mrs Jaana Saarinen for assistance in data collection. Pasi Ohtonen MSc is acknowledged for his invaluable assistance with statistical analyses. Dr Panu Tonttila MD critically evaluated the manuscript during its preparation.

Declaration of interest: PH received travel support from Medtronic.