Preliminary experiences with sacral neuromodulation in the treatment of non-obstructive urinary retention

DOI: 10.22591/magyurol.2017.4.romicsm.167

Authors:
Romics Miklós dr.¹, Kiss Gusztáv dr.², Eross Lóránd dr.³, Nyirády Péter dr.¹, Majoros Attila dr.^1
1Semmelweis Egyetem, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)
²Innsbrucki Orvostudományi Egyetem, Neuro-urológiai Ambulancia, Innsbruck, Ausztria
³Országos Klinikai Idegtudományi Intézet, Funkcionális idegsebészet, Budapest (igazgató: Eross Lóránd dr.)

Summary

Introduction and aims: In our study we proudly present our initial experiences with sacral neuromodulation (SNM) in the treatment of non-obstructive urinary retention trough detrusor hypocontractility.
Patients and methods: Three of our patients, diagnosed with non-obstructive detrusor hypocontractility, have been chosen for the implantation of Interstim neuromodulators (Medtronic, USA) after a thorough urological, neurological and gynecological examination. The male patient (41) received surgery for a spinal herniation before he developed the condition, the two female patients (26 and 42) had no past history to explain their voiding inability: the cause could be interpreted as idiopathic or symptom of Fowler’s syndrome. All our patients were doing intermittent selfcatheterisation 4-5 times a day before the neuromodulation, the conservative treatment methods all failed to improve their situation. After we have demonstrated solid evidence for the indication of SNM, we performed it in two steps: at first – after the bilateral implantation of the sacral electrodes through the sacral 3-4 foramen – we have performed a 2-3 weeks long testmodulation to analyse the effects of the stimuli. The modulation kick started the spontaneous miction for each patient therefore the implantation of the definitive subcutaneous neuromodulator could be performed.
Results: After the implantation of the stimulating devices, the youngest patient could discontinue self-catheterisation, and the others did not need to do it more than 3 times a day (from the initial 5-6). After the operations we did not experience any complications or pain symptoms.
Conclusion: SNM is an effective and minimal invasive alternative solution for non-obstructive urinary retention. After a thorough examination and careful patient selection it can be successfully applied for treating hypocontractile detrusor function.

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