1344 SENSORY OR MOTOR RESPONSES: WHICH ARE MORE IMPORTANT FOR SACRAL NEUROMODULATION FOR VOIDING DYSFUNCTION?

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence—Evaluation & Therapy1 Apr 20111344 SENSORY OR MOTOR RESPONSES: WHICH ARE MORE IMPORTANT FOR SACRAL NEUROMODULATION FOR VOIDING DYSFUNCTION? Michael Guralnick, Nathan Rasmussen, Aniko Szabo, and R. Corey O'Connor Michael GuralnickMichael Guralnick Milwaukee, WI More articles by this author , Nathan RasmussenNathan Rasmussen Milwaukee, WI More articles by this author , Aniko SzaboAniko Szabo Milwaukee, WI More articles by this author , and R. Corey O'ConnorR. Corey O'Connor Milwaukee, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1165AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral neuromodulation (SNS) for refractory voiding dysfunction involves a 2 stage procedure with the 1st stage being a test of stimulation efficacy. This involves implantation of a lead into the S3 foramen to stimulate the nerve. The determination of appropriate lead placement is made by assessing for motor and sensory responses of the S3 nerve. However, it is not always possible to elicit all of the responses. A prior study by Cohen et al (2006) concluded that the motor responses were the most important predictor of a successful test stimulation. The purpose of this study is to review our results of stage I SNS to determine if there is indeed a more important type of response (motor vs. sensory) in determining success. METHODS We retrospectively reviewed the charts of patients undergoing staged SNS for refractory voiding dysfunction (overactive bladder, retention, pelvic pain). Data extracted included the primary indication, the sacral responses elicited during the procedure, and whether or not SNS was successful resulting in progression to stage II (>50% improvement based on symptoms, voiding diaries +/− pad testing). The data was stratified by sex, indication, and presence/absence of neurogenic dysfunction. Patients with incomplete recording of sacral responses during the procedure were excluded. Statistical comparisons between groups was made using the Pearson Chi-square test. RESULTS 172 patients (30 male, 142 female) underwent stage I SNS testing. Overall, 80/142 (56%) had a successful test stimulation and progressed to stage II. In 81% of patients both motor and sensory responses were elicited and 51% of these patients had success. 6% of patients had only a sensory response and 40% of them had success. 8% of patients had only a motor response and 38% of them had success. 6% of patients had no S3 response at all and none had success. These were not statistically significantly different. This continued to be the case upon stratifying by sex, primary indication, and presence/absence of NGB. CONCLUSIONS We could not confirm the results of a prior study that motor responses are more important than the sensory in predicting a successful SNS test stimulation. Rather, we found no statistically significant differences between sensory and motor responses, even when stratifying by sex, indication and presence/absence of neurogenic dysfunction. As such, surgeons should continue to strive to elicit all of the sacral responses when performing the test stimulation, and generally this is feasible. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e537 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Guralnick Milwaukee, WI More articles by this author Nathan Rasmussen Milwaukee, WI More articles by this author Aniko Szabo Milwaukee, WI More articles by this author R. Corey O'Connor Milwaukee, WI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...