Page 107 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

Acute effect of sacral neuromodulation for treatment of detrusor overactivity on urodynamic parameters 105
diary which was evaluated after one week. The PNE was considered positive if at least 50% improvement was obtained in at least one of the symptoms (frequency, voided volume or incontinence episodes). In case the PNE was inconclusive, a first stage tined lead placement test (FSTLP) was proposed in which the permanent lead is placed in one of the S3 or S4 foramens and is connected to an external stimulator. Stimulation parameters were the same as during PNE. This test phase has a duration of about one month and the evaluation of success is done on the basis of bladder diary results of at least three days, which is comparable to the PNE evaluation.
Outcome measures
Demographic data, data from bladder diaries and the results of the PNE and FSTLP, were extracted from the medical record (Table 1). The outcome measures were various UDS parameters as given in Table 2. The results of three different UDS were compared: UDS B (performed at baseline, prior to the PNE, as a part of our standard procedure of care), UDS1 (after the PNE, without stimulation) and UDS2 (after the PNE, with stimulation). During UDS B two filling - voiding cycles were performed. Of these two cycles, the data of the filling phase with the highest filled volume and the data of the voiding phase with the highest maximum flow rate were used in the current study.
Statistical analysis
All statistical analyses were done with the Wilcoxon rank test for non-parametric related samples, using SPSS version 24.0 (IBM Corp., Armonk, NY, USA).
RESULTS
A total of 10 female patients with a mean age of 59 (interquartile range 54-63) years were willing to participate and completed the study protocol, see Table 1 for patient characteristics. All patients had OAB for at least 2 years with proven detrusor overactiv- ity on UDS B. All patients except for one (patient 9) also showed detrusor overactivity during UDS 1 and UDS 2. The PNE was positive in 4 patients, inconclusive in 4 patients and negative in 2 patients (patient 2 and 9). The 4 patients with an inconclusive result reported to feel stimulation during UDS 2 but lost sensation after 2 to 4 days, possibly due to displacement of the lead. An FSTLP was next done, with a positive outcome in all 4 patients. Consequently, a permanent neuromodulator was implanted in 8 patients.
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