Article

OBJECTIVE: To determine the success rate of percutaneous first stage of sacral
neuromodulation (SNM) and the efficacy and safety of permanent SNM for incomplete
spinal cord lesion (SCL) patients suffering from chronic neurogenic
non-obstructive urinary retention (N-NOR). METHOD: From January 2003 to December
2012, 85 individuals underwent the percutaneous first stage of SNM. Subsequently,
only responders who reached a concomitant reduction by at least 50% of volume per
catheterization and in the number of catheterizations per day comparing their
7-day voiding diaries at baseline underwent permanent SNM. Final follow-up was
conducted by April 2013. RESULTS: Thirty-six individuals responded to
percutaneous first stage of SNM. Post-surgery urodynamics documented all patients
experiencing first sensation of bladder filling. A statistically significant
increase in Qmax ml per sec and decrease in post-voiding residual urine per ml
were documented. (P<0.01). First sensation of bladder filling at baseline
represented a statistically significant parameter for the success of the first
stage SNM (P<0.05).
Eleven out of 34 patients at follow-ups were 'inconstant
responders' because they returned to similar baseline voiding symptoms, but
responded again with an implant on the controlateral S3 sacral root. Two failed
twice and responded once again after an S4 sacral root implant. All but one
failure occurred more than 3 years after the previous implant. Other drawbacks
were resolved telemetrically. CONCLUSIONS: Research is needed to increase the
success rate of the first stage SNM on incomplete SCL patients with N-NOR. Permanent SNM is highly efficacious in the medium follow-up.

Langue : ANGLAIS