PD11-12 PREDICTING A SUCCESSFUL OUTCOME WITH SACRAL NEUROMODULATION TESTING: ARE URODYNAMIC PARAMETERS DURING FILLING CYSTOMETRY PROGNOSTIC?

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Evaluation1 Apr 2014PD11-12 PREDICTING A SUCCESSFUL OUTCOME WITH SACRAL NEUROMODULATION TESTING: ARE URODYNAMIC PARAMETERS DURING FILLING CYSTOMETRY PROGNOSTIC? Julie Jenks, Eskinder Solomon, Mahreen Pakzad, Rizwan Hamid, Tamsin Greenwell, Julian Shah, and Jeremy Ockrim Julie JenksJulie Jenks More articles by this author , Eskinder SolomonEskinder Solomon More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , Julian ShahJulian Shah More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.545AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral neuromodulation (SNM) is an effective treatment modality for medically refractory overactive bladder (OAB). Standard selection criteria are based on frequency-volume charts, pad weight (objective) assessments, and patient reported (subjective) outcomes. Little is reported of the utility of urodynamic study in selecting patients for SNM therapy. We assessed whether the urodynamic parameters during filling cystometry correlated with successful outcome from first stage SNM testing. METHODS All OAB patients were screened prior to first stage testing with urodynamics to confirm (idiopathic) detrusor overactivity (IDO). The mean voided volumes, peak amplitude of IDO contraction, compliance and end fill pressure was recorded. Primary outcomes were assessed using frequency-volume charts, pad testing and ICIQ/EQ5D questionnaires. Success was considered if patients achieved >50% improvement in urinary symptoms. Conversion to a permanent SNM implant was undertaken according to response. The predictive value of the four parameters was assessed using binary logistic regression analysis. RESULTS 177 consecutive IDO patients had first stage SNM evaluation between 2010 and 2013. The mean voided volume for patients with successful response was 184 (147-223) mls and for those with failed response 171 (128-214) mls, peak DO pressure was 41.0 (29-52) cmH20 compared to 40 (28-52) cmH20, compliance pressure 12 (7-16) cmH20 compared to 49 (3-95) cmH20, and end fill pressure 25 (19-30) cmH20 compared to 24 (14-33) cmH20. Logistic regression analysis did not demonstrate any significant relationship between peak detrusor pressure and outcome (B = -0.005, 0.001, 0.026, 0.016 respectively) (Figure 1). Figure 1: Box plots representing the distribution of mean void volume, peak DO, compliance and end-fill pressures with first stage SNM testing. Box borders illustrate the upper, median and lower quartiles; whiskers depict the 99% interval. Extreme (star) and mild (circle) outliers are also shown. CONCLUSIONS There was no correlation between any urodynamic parameter and successful SNM outcome. SNM is an option for all IDO patients, regardless of their dynamic bladder function on filling cystometry. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e291 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Julie Jenks More articles by this author Eskinder Solomon More articles by this author Mahreen Pakzad More articles by this author Rizwan Hamid More articles by this author Tamsin Greenwell More articles by this author Julian Shah More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...