World J Urol (2012) 30:123–128 DOI 10.1007/s00345-011-0669-0 123 ORIGINAL ARTICLE Sacral neuromodulation in patients with multiple sclerosis Daniele Minardi · Giovanni Muzzonigro Received: 10 December 2010 / Accepted: 28 February 2011 / Published online: 15 March 2011 © Springer-Verlag 2011 Abstract Purpose We present a case series of patients with multiple sclerosis (MS) and neurogenic lower urinary tract dysfunction treated by sacral neuromodulation (SNM). Methods We reviewed charts of 25 patients who were treated for refractory lower urinary tract symptoms; during the SNM testing phase, patient management included evaluation of number of daily voiding, number of episodes of incontinence, residual urine and quality of life score. Patients who experienced greater than 50% improvement in symptoms of frequency and incontinence episodes and/or a greater than 50% decrease in the number of catheterizations and a greater than 50% increase in voided volumes were oVered placement of the permanent InterStimTM . Results Fifteen patients were implanted with InterStimTM; mean duration of MS was 13.66 years; mean follow-up of patients was 49.4 months. Nine patients were on clean intermittent catheterization, and in all of them, a signiWcant decrease in residual volume with increase in voided volume and number of voiding per day; in 6 patients, the main problem was incontinence, and in them incontinence, episodes decreased and voided volume increased. Sixty-six per cent of patients have a functioning device after a mean follow- up of 61.2 months. Conclusions SNM is a good option in the treatment of voiding dysfunction in patients with MS in a medium to long-term follow-up. Urinary retention due to detrusor underactivity is not a good indication for SNM; it should be oVered to MS patients with refractory urgency urinary incontinence and MS patients with urinary retention due to detrusor-sphincter dyssynergia (DSD). Keywords Neurogenic lower urinary tract dysfunction · Multiple sclerosis · Sacral neuromodulation
Sacral neuromodulation in patients with multiple sclerosis / Minardi, Daniele; Muzzonigro, Giovanni. - In: WORLD JOURNAL OF UROLOGY. - ISSN 0724-4983. - 30:(2012), pp. 123-128. [10.1007/s00345-011-0669-0 123]
Sacral neuromodulation in patients with multiple sclerosis.
MINARDI, Daniele;MUZZONIGRO, GIOVANNI
2012-01-01
Abstract
World J Urol (2012) 30:123–128 DOI 10.1007/s00345-011-0669-0 123 ORIGINAL ARTICLE Sacral neuromodulation in patients with multiple sclerosis Daniele Minardi · Giovanni Muzzonigro Received: 10 December 2010 / Accepted: 28 February 2011 / Published online: 15 March 2011 © Springer-Verlag 2011 Abstract Purpose We present a case series of patients with multiple sclerosis (MS) and neurogenic lower urinary tract dysfunction treated by sacral neuromodulation (SNM). Methods We reviewed charts of 25 patients who were treated for refractory lower urinary tract symptoms; during the SNM testing phase, patient management included evaluation of number of daily voiding, number of episodes of incontinence, residual urine and quality of life score. Patients who experienced greater than 50% improvement in symptoms of frequency and incontinence episodes and/or a greater than 50% decrease in the number of catheterizations and a greater than 50% increase in voided volumes were oVered placement of the permanent InterStimTM . Results Fifteen patients were implanted with InterStimTM; mean duration of MS was 13.66 years; mean follow-up of patients was 49.4 months. Nine patients were on clean intermittent catheterization, and in all of them, a signiWcant decrease in residual volume with increase in voided volume and number of voiding per day; in 6 patients, the main problem was incontinence, and in them incontinence, episodes decreased and voided volume increased. Sixty-six per cent of patients have a functioning device after a mean follow- up of 61.2 months. Conclusions SNM is a good option in the treatment of voiding dysfunction in patients with MS in a medium to long-term follow-up. Urinary retention due to detrusor underactivity is not a good indication for SNM; it should be oVered to MS patients with refractory urgency urinary incontinence and MS patients with urinary retention due to detrusor-sphincter dyssynergia (DSD). Keywords Neurogenic lower urinary tract dysfunction · Multiple sclerosis · Sacral neuromodulationI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
