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Pregnancy in women with Fowler’s syndrome treated with sacral neuromodulation

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Abstract

Introduction and hypothesis

Our aim was to determine the impact of pregnancy on sacral neuromodulation (SNM) and vice versa in patients with Fowler’s syndrome (FS), which is typified by chronic urinary retention (CUR).

Methods

We performed a retrospective study of pregnancy in patients with FS who underwent a two-stage SNM implantation. Data were obtained using a standard questionnaire and clinical interview.

Results

There were a total of ten patients with 13 pregnancies. The SNM was switched off in ten of the 13 pregnancies, with CUR recurring in nine of the ten pregnancies and recurrent urinary tract infections (UTI) occurring in four of these pregnancies (more than three UTI in the pregnancy). Those in whom the device was left on continued to void normally. One woman had a first trimester miscarriage, eight pregnancies went to term, and four deliveries were premature. Caesarean section was performed in eight pregnancies for obstetric reasons. Four pregnancies resulted in a vaginal delivery. There were no congenital anomalies reported. Following delivery, four of nine women experienced dysfunction of their SNM device when it was switched back on.

Conclusion

Turing off the SNM during pregnancy results in recurrence of CUR, with an increased risk of recurrent UTI associated with preterm delivery. This did not impact foetal well-being. The option of keeping the SNM on during pregnancy should therefore be considered, and as caesarean section affects the SNM device, we advise that caesarean section should only be performed for obstetric reasons.

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Funding

No manufacturing company was involved in this study. Funding was not required.

Conflicts of interest

Azar Khunda, Roopali Karmarkar and Bahareh Abtahi have no conflict of interest to declare. Gwen Gonzales has run a trial for Medtronic, and Sohier Elneil works as a consultant for Medtronic.

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Authors and Affiliations

  1. Department of Uro-neurology, National Hospital of Neurology and Neurosurgery, London, WC1B 3BG, UK

    Azar Khunda, Roopali Karmarkar, Bahareh Abtahi, Gwen Gonzales & Sohier Elneil

  2. Department of Uro-neurology, National Hospital of Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Sohier Elneil

Authors
  1. Azar Khunda
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  2. Roopali Karmarkar
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  3. Bahareh Abtahi
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  4. Gwen Gonzales
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  5. Sohier Elneil
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Corresponding author

Correspondence to Sohier Elneil.

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Khunda, A., Karmarkar, R., Abtahi, B. et al. Pregnancy in women with Fowler’s syndrome treated with sacral neuromodulation. Int Urogynecol J 24, 1201–1204 (2013). https://doi.org/10.1007/s00192-012-1999-1

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  • DOI: https://doi.org/10.1007/s00192-012-1999-1

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