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Sacral neuromodulation in patients with multiple sclerosis

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Abstract

Purpose

We present a case series of patients with multiple sclerosis (MS) and neurogenic lower urinary tract dysfunction treated by sacral neuromodulation (SNM).

Methods

We reviewed charts of 25 patients who were treated for refractory lower urinary tract symptoms; during the SNM testing phase, patient management included evaluation of number of daily voiding, number of episodes of incontinence, residual urine and quality of life score. Patients who experienced greater than 50% improvement in symptoms of frequency and incontinence episodes and/or a greater than 50% decrease in the number of catheterizations and a greater than 50% increase in voided volumes were offered placement of the permanent InterStimTM .

Results

Fifteen patients were implanted with InterStimTM; mean duration of MS was 13.66 years; mean follow-up of patients was 49.4 months. Nine patients were on clean intermittent catheterization, and in all of them, a significant decrease in residual volume with increase in voided volume and number of voiding per day; in 6 patients, the main problem was incontinence, and in them incontinence, episodes decreased and voided volume increased. Sixty-six per cent of patients have a functioning device after a mean follow-up of 61.2 months.

Conclusions

SNM is a good option in the treatment of voiding dysfunction in patients with MS in a medium to long-term follow-up. Urinary retention due to detrusor underactivity is not a good indication for SNM; it should be offered to MS patients with refractory urgency urinary incontinence and MS patients with urinary retention due to detrusor-sphincter dyssynergia (DSD).

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Acknowledgments

We thank Dr. Limido Lucia (Medtronic—Italia S.p.A.) for technical advice.

Conflict of interest

The authors certify that there is no actual or potential conflict of interest in relation to this article

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Authors and Affiliations

  1. Department of Clinic and Specialistic Sciences—Urology, Polytechnic University of the Marches Region—Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy

    Daniele Minardi & Giovanni Muzzonigro

  2. Clinica Urologia, Università Politecnica delle Marche, A.O. Ospedali Riuniti, Via Conca, 71, 60020, Ancona, Italy

    Daniele Minardi

Authors
  1. Daniele Minardi
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  2. Giovanni Muzzonigro
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Correspondence to Daniele Minardi.

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Minardi, D., Muzzonigro, G. Sacral neuromodulation in patients with multiple sclerosis. World J Urol 30, 123–128 (2012). https://doi.org/10.1007/s00345-011-0669-0

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  • DOI: https://doi.org/10.1007/s00345-011-0669-0

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