Abstract
Purpose of Review
Sacral neuromodulation (SNM) is a widely accepted and minimally invasive treatment for several urologic lower urinary tract pathologies and bowel dysfunction. Treatment for pelvic malignancies is associated with significant rates of urinary, sexual, and fecal dysfunction. The authors sought to determine the role SNM should play in the management of voiding and fecal dysfunction in the male and female cancer survivor patient. There is a lack of studies looking at SNM in the cancer survivor population, particularly in the setting of radiation cystitis or proctitis. Regardless, the authors feel there is a role for SNM in this population. Further studies are needed to further delineate this role and the efficacy of SNM in this challenge to treat patient population.
Recent Findings
Voiding dysfunction in the cancer survivor population including urinary urgency, frequency, and urge incontinence is very common. Similarly, fecal incontinence occurs not infrequently and is a major source of patient distress. There is great evidence for SNM via InterStim in urinary urgency, urge incontinence, non-obstructive retention, and fecal incontinence. Studies are lacking, however, in the cancer survivor population. They are non-existent in the postradiation patient population.
Summary
SNM is a good treatment option for urinary urgency, urge incontinence, non-obstructive urinary retention, and fecal incontinence. More studies are needed in the cancer survivor population, particularly following radiation therapy. Regardless, the authors feel there is a role in the cancer survivor for SNM.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
• Wollner J, Hampel C, Kessler TM. Surgery illustrated—surgical atlas sacral neuromodulation. BJU Int. 2012;110(1):146–59. This is an excellent illustrated guide on InterStim implantation technique.
Van Kerrebroeck PE, Marcelissen TA. Sacral neuromodulation for lower urinary tract dysfunction. World J Urol. 2012;30(4):445–50.
• Liberman D, Ehlert MJ, Siegel SW. Sacral neuromodulation in urological practice. Urology. 2017;99:14–22. This is an excellent review of InterStim outcomes from a high volume inplanter.
• Elliott SP, Malaeb BS. Long-term urinary adverse effects of pelvic radiotherapy. World J Urol. 2011;29(1):35–41. An excellent review of radiotherapy and its effects on patients.
Penson DF, Litwin MS. Quality of life after treatment for prostate cancer. Curr Urol Rep. 2003;4(3):185–95.
Das AK, White MD, Longhurst PA. Sacral nerve stimulation for the management of voiding dysfunction. Reviews in Urology. 2000;2(1):43–60.
Mayer RD, Howard FM. Sacral nerve stimulation: neuromodulation for voiding dysfunction and pain. Neurotherapeutics. 2008;5(1):107–13.
Hassouna MM, et al. Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. J Urol. 2000;163(6):1849–54.
Siegel SW, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology. 2000;56(6 Suppl 1):87–91.
Jonas U, et al. Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol. 2001;165(1):15–9.
White WM, et al. Sacral nerve stimulation for treatment of refractory urinary retention: long-term efficacy and durability. Urology. 2008;71(1):71–4.
Janssen PT, et al. Fecal incontinence treated by sacral neuromodulation: long-term follow-up of 325 patients. Surgery. 2017;161(4):1040–8.
Lange MM, van de Velde CJ. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol. 2011;8(1):51–7.
Kim JH, et al. Voiding dysfunction after total mesorectal excision in rectal cancer. International Neurourology Journal. 2011;15(3):166–71.
Ameda K, et al. The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer. Int J Urol. 2005;12(3):256–63.
Bregendahl S, et al. Urinary and sexual dysfunction in women after resection with and without preoperative radiotherapy for rectal cancer: a population-based cross-sectional study. Color Dis. 2015;17(1):26–37.
Katepratoom C, Manchana T, Amornwichet N. Lower urinary tract dysfunction and quality of life in cervical cancer survivors after concurrent chemoradiation versus radical hysterectomy. Int Urogynecol J. 2014;25(1):91–6.
Steineck G, et al. Quality of life after radical prostatectomy or watchful waiting. N Engl J Med. 2002;347(11):790–6.
Schwandner O. Sacral neuromodulation for fecal incontinence and “low anterior resection syndrome” following neoadjuvant therapy for rectal cancer. Int J Color Dis. 2013;28(5):665–9.
Ratto C, et al. Sacral neuromodulation in treatment of fecal incontinence following anterior resection and chemoradiation for rectal cancer. Dis Colon rectum. 2005;48(5):1027–36.
Sunesen KG, et al. Long-term anorectal, urinary and sexual dysfunction causing distress after radiotherapy for anal cancer: a Danish multicentre cross-sectional questionnaire study. Color Dis. 2015;17(11):O230–9.
Resnick MJ, et al. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013;368(5):436–45.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Dr. Zaid declares no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the author.
Additional information
This article is part of the Topical Collection on Cancer-Associated Voiding Dysfunction
Rights and permissions
About this article
Cite this article
Zaid, U.B. Neuromodulation in the Treatment of Voiding Dysfunction and Fecal Incontinence in Male and Female Cancer Survivors. Curr Bladder Dysfunct Rep 12, 138–142 (2017). https://doi.org/10.1007/s11884-017-0423-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11884-017-0423-6