Highlights From the Combined Society of Urodynamics and Female Urology and International Society of Pelvic Neuromodulation Annual Meeting

Abstract

The second annual meeting of SUFU was held in conjunction with the annual meeting of the ISPiN on February 24 to 27, 2005 in Orlando, Florida. Presentations representing a broad range of research topics were combined with smaller breakout sessions, and state-of-theart lectures were offered in the areas of pelvic prolapse, translational applications of smooth muscle dysfunction in pelvic floor diseases and the role of urothelium in bladder pathology. Highlights of the lectures and reported abstracts are summarized. NEUROMODULATION Technique The technique of SNS has continued to evolve. Performance of a staged implant using a tined lead as an initial test, the use of intraoperative neurophysiological monitoring and a prolonged trial period of up to 1 month before completion of a second stage procedure were all factors that have been found to enhance therapy outcomes. Patients in whom an initial trial of SNS has failed using a staged implant technique may be salvaged by a repeat trial. There is emerging interest in PNS as an alternative to SNS. The techniques for accessing the pudendal nerve are varied and the use of neurophysiological monitoring is routinely advocated for PNS. There may be an advantage of this approach in patients with neurogenic voiding disorders or in those in whom prior SNS attempts have failed. A prospective, singleblinded, randomized, crossover trial comparing SNS to PNS was reported and there appeared to be a large proportion of neuromodulation naive patients who initially preferred PNS to SNS. The long-term results of PNS are not available for comparison at this point and its role as an alternative to SNS is under active evaluation. Patient Selection The role of SNS in neurogenic voiding disorders was explored. Patients with voiding dysfunction due to multiple sclerosis, cerebrovascular accident, SCI and other neuropathies were shown to respond favorably to a staged trial and chronic stimulation. Up to 70% success of a trial stimulation in patients with multiple sclerosis was reported, while only a third of patients with lumbar disc disease responded favorably. Patients with IC respond favorably to SNS and PNS. Despite the encouraging high success in patients with IC, as defined by progression to stage 2 implantation, there may be a decrease in clinical efficacy in the long term with only a 48% long-term success rate noted overall.