Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction.

STUDY DESIGN: This is a retrospective chart analysis. OBJECTIVES: The objective of this study was to evaluate the effect of sacral neuromodulation (SNM) in patients with neurogenic lower urinary tract dysfunction (NLUTD). SETTINGS: This study was conducted in a spinal cord injury rehabilitation center in Switzerland. METHODS: The charts of all patients who underwent SNM (testing and/or permanent implantation) because of NLUTD at our institution between 2007 and 2013 were evaluated. Treatment outcomes and complications were recorded. RESULTS: A total of 50 patients, 30 women and 20 men, with a mean age of 46 (±14) years, fulfilled the inclusion criteria. The most frequent cause for SNM was spinal cord injury in 35 patients (70%). Median duration of the underlying disease was 9.5 (±9.3) years. In all, 35 patients (70%) received a permanent implant. The complication rate was 16% (8/50). At the last follow-up, SNM was in use in 32 patients. In 26 patients with SNM because of detrusor overactivity, voiding frequency per 24 h was significantly reduced from 9 to 6, and daily pad use rate was significantly improved (2.6 versus 0.6 pads per 24h). On comparing urodynamic assessment of detrusor function before and under SNM, no significant suppression of neurogenic detrusor overactivity (NDO) was detected. In nine patients with chronic neurogenic urinary retention, median postvoid residual urine was significantly reduced from 370 to 59 ml. In all, 94% of the patients were either very satisfied or satisfied with SNM. CONCLUSION: SNM might be an additional therapy option in carefully selected patients with NLUTD. On the basis of our results, urodynamic evaluation before SNM is mandatory, as the procedure does not seem to be suited to significantly alleviate NDO.

Use of complementary and alternative medicine in persons with spinal cord injury in Switzerland: a survey study.

STUDY DESIGN: Questionnaire-based survey study. OBJECTIVES: To evaluate the use of and the satisfaction with complementary and alternative medicine (CAM) techniques in patients with spinal cord injury (SCI). SETTING: Rehabilitation Center, Switzerland. METHODS: Between May and September 2014, all patients with chronic (>1 year) SCI attending the urologic outpatient clinic were asked to fill in a questionnaire regarding the use of CAM. RESULTS: Of the 103 participants (66 men and 37 women), 73.8% stated that they have used some form of CAM since SCI, with acupuncture and homeopathy being the two techniques that were used most frequently (31% each). The most common indications for CAM use were pain and urinary tract infections (UTIs). CAM was used supplementarily rather than exclusively. Overall satisfaction (85.1%) as well as satisfaction rates for the different indications (pain: 85%; UTI: 90.5%) and for the most frequently used forms of CAM (homeopathy: 90.6%; acupuncture: 78.1%) were high. CONCLUSION: According to our data, there is a demand for adjunctive CAM procedures for the treatment of medical complications by persons with SCI. CAM led to high satisfaction levels. On the basis of these results, future research should systematically evaluate the therapeutic potential of the most popular CAM techniques, for example, acupuncture and homeopathy, for the treatment of secondary medical complications of SCI.

[Extracorporeal magnetic innervation: a non-invasive therapy for urinary incontinence?]. / "Extracorporeal magnetic innervation" : Eine Ergänzung der konservativen Inkontinenztherapie?

OBJECTIVE: Extracorporeal magnetic innervation (ExMI) is a non-invasive therapy for treatment of urinary incontinence (UI). The aim of the current study was to evaluate the efficacy of ExMI in a prospective case series. PATIENTS AND METHODS: Over a period of 1.5 years 63 consecutive patients with a clinically and urodynamically confirmed diagnosis of urinary incontinence were enrolled. All patients requested an additional non-surgical therapy option and the ExMI system (Neo control™, Kitalpha, USA) was used. The therapy consisted of 12 treatment sessions two to three times a week. Primary outcome parameter was reduction of the number of pads per 24 h and secondary outcome parameters were patient satisfaction, adverse events and duration of the therapeutic effect. RESULTS: A total of 63 patients (57 male and 6 female), mean age 68±7.1 years were recruited. After completion a significant (p=0.001) reduction of the number of pads used per 24 h was observed (from 5.4±3.7 to 2.7±2.5) which persisted after a median follow-up of 12.5 months (2.3±2.2 pads per 24 h). Also patients suffering from UI after prostatectomy revealed a significant (p=0.001) reduction in the number of pads from 4.8±2.9 to 2.6±2.6 with persistence at 2.5±2.5 at follow-up. Transient, self-limiting perineal pain in three patients was the only reported side effect. CONCLUSIONS: The ExMI procedure is an additional non-invasive therapy option for patients with urinary incontinence. However, sham-controlled studies are required to corroborate the therapy effect.

[Sacral neuromodulation for neurogenic bladder dysfunction]. / Sakrale Neuromodulation bei neurogenen Blasenfunktionsstörungen.

Sacral neuromodulation (SNM) represents a promising option for managing treatment-refractory neurogenic bladder dysfunction. It remains to be seen, however, which types of neurogenic bladder dysfunction and which underlying neurological disorders best respond to SNM. Constant improvements in SNM have been achieved and it is now a minimally invasive approach performed under local anesthesia which should be considered before undertaking larger reconstructive procedures. An electrode is implanted in the S3 or S4 sacral foramen and during a test phase lasting for days to weeks the patient keeps a bladder diary to determine whether SNM has provided a relevant benefit. If the results of the test phase are positive, a neuromodulator is implanted in the gluteal area (or more rarely in the abdominal wall).The mechanism of action of SNM has not been completely clarified, but the afferent nerves most likely play a key role. It appears that SNM produces a modulation of medullary reflexes and brain centers by peripheral afferents. The implanted neuromodulation system does not lead to limitation of the patient's activities. However, it should be noted that high-frequency diathermy and unipolar electrocauterization are contraindicated in patients with neuromodulators, that during extracorporeal shock wave lithotripsy the focal point should not be in the direct vicinity of the neuromodulator or the electrode, that ultrasound and radiotherapy in the region of the implanted components should be avoided, that the neuromodulation should be discontinued in pregnancy, and that MRI examinations should only be conducted when urgently indicated and the neuromodulator is turned off.