Skip to main content

Advertisement

SpringerLink
Log in

Development of a predictive tool for sacral nerve modulation implantation in the treatment of non-obstructive urinary retention and/or slow urinary stream: a study from the Neuro-Urology Committee of the French Association of Urology

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to seek predictive factors and develop a predictive tool for sacral nerve modulation (SNM) implantation in patients with non-obstructive urinary retention and/or slow urinary stream (NOUR/SS).

Methods

This study was designed as a retrospective study including all patients who have undergone a two-stage SNM for NOUR/SS between 2000 and 2021 in 11 academic hospitals. The primary outcome was defined as the implantation rate. Secondary outcomes included changes in bladder emptying parameters. Univariate and multivariable logistic regression analysis were performed and determined odds ratio for IPG implantation to build a predictive tool. The performance of the multivariable model discrimination was evaluated using the c-statistics and an internal validation was performed using bootstrap resampling.

Results

Of the 357 patients included, 210 (58.8%) were finally implanted. After multivariable logistic regression, 4 predictive factors were found, including age (≤ 52 yo; OR = 3.31 CI95% [1.79; 6.14]), gender (female; OR = 2.62 CI95% [1.39; 4.92]), maximal urethral closure pressure (≥ 70 cmH2O; OR: 2.36 CI95% [1.17; 4.74]), and the absence of an underlying neurological disease affecting the lower motor neuron (OR = 2.25 CI95% [1.07; 4.76]). Combining these factors, we established 16 response profiles with distinct IPG implantation rates, ranging from 8.7 to 81.5%. Internal validation found a good discrimination value (c-statistic, 0.724; 95% CI 0.660–0.789) with a low optimism bias (0.013). This allowed us to develop a predictive tool (https://predictivetool.wixsite.com/void).

Conclusion

The present study identified 4 predictive factors, allowing to develop a predictive tool for SNM implantation in NOUR/SS patients, that may help in guiding therapeutic decision-making. External validation of the tool is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

BNI:

Bladder neck incision

BPH:

Benign prostatic hyperplasia

BVE:

Bladder voiding efficiency

CISC:

Intermittent self‐catheterization

DPE:

Deep pelvic endometriosis

IPG:

Implantable pulse generator

LMN:

Lower motor neuron

MUCP:

Maximal urethral closure pressure

OAB:

Overactive bladder

PVR:

Post-void residual

Q max :

Maximum urine flow rate

SNM:

Sacral nerve modulation

TURP:

Transurethral resection of the prostate

UMN:

Upper motor neuron

NOUR/SS:

Non-obstructive urinary retention and/or slow urinary stream

References

  1. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A et al (2016) Erratum to: an International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 27(4):655–684

    Article  PubMed  Google Scholar 

  2. D’Ancona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H et al (2019) The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 38(2):433–477

    Article  PubMed  Google Scholar 

  3. Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V et al (2014) Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol 65(2):389–398

    Article  PubMed  Google Scholar 

  4. Gamé X, Phé V, Castel-Lacanal E, Forin V, de Sèze M, Lam O et al (2020) Intermittent catheterization: clinical practice guidelines from Association Française d’Urologie (AFU), Groupe de Neuro-urologie de Langue Française (GENULF), Société Française de Médecine Physique et de Réadaptation (SOFMER) and Société Interdisciplinaire Francophone d’UroDynamique et de Pelvi-Périnéologie (SIFUD-PP). Prog Urol 30(5):232–251

    Article  PubMed  Google Scholar 

  5. Roberson D, Newman DK, Ziemba JB, Wein A, Stambakio H, Hamilton RG et al (2021) Results of the patient report of intermittent catheterization experience (PRICE) study. Neurourol Urodyn 40(8):2008–2019

    Article  PubMed  Google Scholar 

  6. Tanagho EA, Schmidt RA (1988) Electrical stimulation in the clinical management of the neurogenic bladder. J Urol 140(6):1331–1339

    Article  CAS  PubMed  Google Scholar 

  7. Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M, Farag F et al (2022) European Association of Urology Guidelines on the management of female non-neurogenic lower urinary tract symptoms. Part 2: underactive bladder, bladder outlet obstruction, and nocturia. Eur Urol 82(1):60–70

    Article  PubMed  Google Scholar 

  8. Jairam R, Drossaerts J, Marcelissen T, van Koeveringe G, Vrijens D, van Kerrebroeck P (2022) Predictive factors in sacral neuromodulation: a systematic review. Urol Int 106(4):323–343

    Article  PubMed  Google Scholar 

  9. Gross C, Habli M, Lindsell C, South M (2010) Sacral neuromodulation for nonobstructive urinary retention: a meta-analysis. Female Pelvic Med Reconstr Surg 16(4):249–253

    Article  PubMed  Google Scholar 

  10. Ho FCS, He C, Yao HH, O’Connell HE, Gani J (2021) Efficacy of sacral neuromodulation and percutaneous tibial nerve stimulation in the treatment of chronic nonobstructive urinary retention: a systematic review. Neurourol Urodyn 40(5):1078–1088

    Article  PubMed  Google Scholar 

  11. Chartier-Kastler E, Le Normand L, Ruffion A, Dargent F, Braguet R, Saussine C et al (2021) Sacral neuromodulation with the InterStim™ system for intractable lower urinary tract dysfunctions (SOUNDS): results of clinical effectiveness, quality of life, patient-reported outcomes and safety in a french multicenter observational study. Eur Urol Focus 7(6):1430–1437

    Article  PubMed  Google Scholar 

  12. Goldman HB, Lloyd JC, Noblett KL, Carey MP, Castaño Botero JC, Gajewski JB et al (2018) International Continence Society best practice statement for use of sacral neuromodulation. Neurourol Urodyn 37(5):1823–1848

    Article  PubMed  Google Scholar 

  13. Harrell FE, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Statist Med 15(4):361–387

    Article  Google Scholar 

  14. Gani J, Hennessey D (2017) The underactive bladder: diagnosis and surgical treatment options. Transl Androl Urol 6(S2):S186–S195

    Article  PubMed  PubMed Central  Google Scholar 

  15. Patra PB, Patra S (2013) Sex differences in the physiology and pharmacology of the lower urinary tract. Curr Urol 6(4):179–188

    Article  PubMed  PubMed Central  Google Scholar 

  16. Coolen RL, Groen J, Stillebroer AB, Scheepe JR, Witte LPW, Blok BFM (2022) Two-staged sacral neuromodulation for the treatment of nonobstructive urinary retention: a multicenter study assessing predictors of success. Neuromodulation [Internet]. 2022 Jun 9 [cited 2022 Dec 23];0(0). https://www.neuromodulationjournal.org/article/S1094-7159(22)00653-5/fulltext

  17. Saber-Khalaf M, Abtahi B, Gonzales G, Helal M, Elneil S (2015) Sacral neuromodulation outcomes in male patients with chronic urinary retention. Neuromodul Technol Neural Interface. 18(4):329–334

    Article  Google Scholar 

  18. Al Hashimi I, Saussine C, Tricard T (2022) Sacral neuromodulation in the management of non-obstructive urinary retention: test phase and predictive factors. Prog Urol S1166–7087(22):00474–00482

    Google Scholar 

  19. High RA, Winkelman W, Panza J, Sanderson DJ, Yuen H, Halder GE et al (2021) Sacral neuromodulation for symptomatic chronic urinary retention in females: do age and comorbidities make a difference? Int Urogynecol J 32(10):2703–2715

    Article  PubMed  Google Scholar 

  20. Yu YD, Jeong SJ (2017) Epidemiology of underactive bladder: common but underresearched. Investig Clin Urol 58(Suppl 2):S68-74

    Article  PubMed  PubMed Central  Google Scholar 

  21. Panicker JN, Fowler CJ, Kessler TM (2015) Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol 14(7):720–732

    Article  PubMed  Google Scholar 

  22. Timoh KN, Canlorbe G, Verollet D, Peyrat L, Ballester M, Amarenco G et al (2015) Contribution of sacral neuromodulation to manage persistent voiding dysfunction after surgery for deep infiltrating endometriosis with colorectal involvement: preliminary results. Eur J Obstet Gynecol Reprod Biol 1(190):31–35

    Article  Google Scholar 

  23. Agnello M, Vottero M, Bertapelle P (2021) Sacral neuromodulation to treat voiding dysfunction in patients with previous pelvic surgery for deep infiltrating endometriosis: our centre’s experience. Int Urogynecol J 32(6):1499–1504

    Article  PubMed  Google Scholar 

  24. Gamé X, Khan S, Panicker J, Hamid R, Elneil S, Fowler C (2010) 2-Stage sacral neuromodulation for treating chronic urinary retention in women: outcome and response prognostic factors. Neurourol Urodyn 21:1081–1083

    Google Scholar 

  25. De Wachter S, Vaganee D, Kessler TM (2020) Sacral neuromodulation: mechanism of action. Eur Urol Focus 6(5):823–825

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for conducting this study.

The Committee of Neuro-Urology of the French Association of Urology gave total support to conduct this collaborative project.

Author information

Authors and Affiliations

  1. Department of Urology, Lille Academic Hospital, Univ. Lille, 59000, Lille, France

    Jordan Nasri, Amelie Demeestere & Xavier Biardeau

  2. Department of Urology, Strasbourg Academic Hospital, University of Strasbourg, Strasbourg, France

    Intisar Al Ashimi, Thibault Tricard & Christian Saussine

  3. Department of Urology, Rennes Academic Hospital, University of Rennes, Rennes, France

    Raphael Fleury & Benoit Peyronnet

  4. Department of Urology, Nimes Academic Hospital, University of Montpellier, Nimes, France

    Imad Matta, Elsa Bey & Laurent Wagner

  5. Department of Urology, Hotel Dieu Hospital, University of Nantes, Nantes, France

    Benoit Mesnard & Marie-Aimée Perrouin-Verbe

  6. Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Academic Hospital, Marseille, France

    Sarah Gaillet & Gilles Karsenty

  7. Department of Biostatistics, CHU Lille, 59000, Lille, France

    Claire Martin

  8. Department of Urology, Rangueil Academic Hospital, University of Toulouse, Toulouse, France

    Xavier Game

  9. Department of Urology, Grenoble Academic Hospital, University of Grenoble, Grenoble, France

    Caroline Thuillier

  10. Department of Urology, Sorbonne Université, Assistance Publique, Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière Academic Hospital, Paris, France

    Emmanuel Chartier-Kastler

  11. Department of Urology, Valenciennes Hospital, Valenciennes, France

    Amelie Demeestere

  12. Department of Urology, Hospices Civils de Lyon, Lyon Sud Hospital, 69310, Pierre-Bénite, France

    Alain Ruffion

  13. Equipe 2, Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, Villeurbanne, France

    Alain Ruffion

  14. Department of Urology, Sorbonne Université, Assistance Publique, Hôpitaux de Paris (AP-HP), Tenon Academic Hospital, Paris, France

    Véronique Phé

  15. Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, F-59000, Lille, France

    Patrick Vermersch & Xavier Biardeau

  16. Department of Urology, Antwerp University Hospital, Edegem, Belgium

    Stefan De Wachter

  17. Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wlrijk, Belgium

    Stefan De Wachter

  18. Department of Urology, Claude Huriez Hospital, 1 rue Michel Polonovski, 59037, Lille Cedex, France

    Xavier Biardeau

Authors
  1. Jordan Nasri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Intisar Al Ashimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thibault Tricard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raphael Fleury
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Imad Matta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elsa Bey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Benoit Mesnard
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sarah Gaillet
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Claire Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Xavier Game
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Caroline Thuillier
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Emmanuel Chartier-Kastler
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Gilles Karsenty
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Marie-Aimée Perrouin-Verbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Amelie Demeestere
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Laurent Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Alain Ruffion
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Benoit Peyronnet
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Christian Saussine
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Véronique Phé
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Patrick Vermersch
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Stefan De Wachter
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Xavier Biardeau
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JN, VP, and XB contributed to concept and design. JN, IAA, TT, RF, IM, EB, BM, SG, and AD were involved in acquisition of data. JN, XB, M-A-V, XG, LW, EC-K, GK, AR, BP, CS, and CT performed analysis and interpretation of data. JN and XB drafted the manuscript. VP, SDW, PV, XG, CT, EC-K, GK, M-A-V, AD, LW, AR, BP, CS, CM, IA, TT, RF, IM, EB, BM, and SG performed critical revision of the manuscript. CM did statistical analysis. XB, VP, SDW, and PV were involved in supervision.

Corresponding author

Correspondence to Xavier Biardeau.

Ethics declarations

Conflict of interest

Jordan NASRI, Intasar AL ASHIMI, Thibault TRICARD, Raphael FLEURY, Imad MATTA, Elsa BEY, Benoit MESNARD, Sarah GAILLET, Claire MARTIN, Xavier GAME, Gilles KARSENTY, Amélie DEMEESTERE, Véronique PHE, and Patrick VERMERSCH declare that they have no conflict of interest. Caroline THUILLIER received support from Coloplast, Hollister, B Braun, Medtronic, Abbvie, and Stimuli technology. Emmanuel CHARTIER-KASTLER received support from Boston Scientific, Medtronic, Coloplast, Convatec, BBraun, Uromems, and TBF (Tissue Bank of France). Marie-Aimée PERROUIN-VERBE received support from Medtronic, Abbvie, Ipsen, and Uromedica. Laurent WAGNER received support from Coloplast, Neomedic, and ABMedica. Alain RUFFION, Christian SAUSSINE, and Stefan DE WACHTER received support from Medtronic. Benoit PEYRONNET: Medtronic, Boston Scientific, Ipsen, IBSA, Pierre Fabre, Intuitive, Schwa-Medico, Abbvie. Xavier BIARDEAU received support from Medtronic, Ipsen, Abbvie, Coloplast, Hollister, BD, and Convatec.

Research involving human participants

In France, clinical retrospective studies focusing on human participants require a commitment to comply to the reference methodology MR-004 through a declaration to the French Advisory Committee on Information Processing in Material Research in the Field of Health (Commission Nationale Informatique et Liberté – CNIL) through the Data Protection Officer (DPO) of the promoting center. The reference methodology MR-004 provides a framework for the processing of personal data for the purposes of studies relating to the re-use of data. The present retrospective study has therefore been declared to the DPO of Lille University Hospital under the reference DEC21-242.

Informed consent

In France, retrospective clinical studies involving human participants require the sponsor to disseminate information to patients whose data will be used in this study, and to give patients the opportunity to object to the use of their data. Thus, in this retrospective study, all patients whose data were to be reused were sent an information note and an objection document.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nasri, J., Al Ashimi, I., Tricard, T. et al. Development of a predictive tool for sacral nerve modulation implantation in the treatment of non-obstructive urinary retention and/or slow urinary stream: a study from the Neuro-Urology Committee of the French Association of Urology. World J Urol 41, 3075–3082 (2023). https://doi.org/10.1007/s00345-023-04638-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-023-04638-y

Keywords

Search

Navigation