Prospective Trial of Sacral Neuromodulation for Refractory Overactive Bladder Syndrome in Korean Patients

Abstract

OBJECTIVES: To evaluate the efficacy and safety of sacral neuromodulation for treating patients with refractory overactive bladder based on urodynamic data.

METHODS: Patients older than 18 years of age, with overactive bladder symptoms refractory to conventional therapies were eligible. Patients with more than a 50% reduction in frequency, urgency, or urge incontinence symptoms during a 2-week test stimulation period retained the sacral neuromodulation. Voiding diaries, overactive bladder questionnaires, and urodynamic studies were performed before and 1 year after sacral neuromodulation.

RESULTS: Forty patients received sacral neuromodulation and 31 patients of those were followed more than 1 year. The mean age of the 31 patients was 54.2 ± 15.4 (range, 30-76) years, and the mean duration of symptoms was 4.4 ± 5.7 (range, 1-31) years. After 12 months of sacral neuromodulation, significant decreases in the episodes of daily urgency (from 20.2 to 5.7, P < 0.001), urgency incontinence (from 7.3 to 0.2; P = 0.011), day time micturition (from 21.8 to 9.9; P < 0.001), night time micturition (from 3.2 to 1.2; P = 0.006) and in severity of urgency episodes (from 3.8 to 2.7; P = 0.015) were observed compared to baseline. Significant increases occurred in bladder volume at the first unstable contraction (from 182.4 ± 92.7 to 216.8 ± 115.6 mL), bladder volume at first desire to void (from 150.5 ± 90.8 to 167.8 ± 81.5 mL), maximal cystometric capacity (from 260.7 ± 120.4 to 291.7 ± 124.3 mL) and bladder volume at urgency sensation (from 182.4 ± 92.7 to 208.2 ± 106.6 mL) (all P < 0.05).

CONCLUSIONS: Sacral neuromodulation is an effective and safe treatment for refractory overactive bladder.