PD32-10 OUTCOMES OF SACRAL NEUROMODULATION IN DETRUSOR HYPERACTIVITY WITH IMPAIRED CONTRACTILITY

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II1 Apr 2018PD32-10 OUTCOMES OF SACRAL NEUROMODULATION IN DETRUSOR HYPERACTIVITY WITH IMPAIRED CONTRACTILITY Katherine Amin, Dena Moskowitz, Alvaro Lucioni, Una J Lee, and Kathleen C Kobashi Katherine AminKatherine Amin More articles by this author , Dena MoskowitzDena Moskowitz More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , Una J LeeUna J Lee More articles by this author , and Kathleen C KobashiKathleen C Kobashi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1553AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite symptoms of urinary urgency/frequency, some patients are unable to empty their bladder to completion. Detrusor hyperactivity with impaired contractility (DHIC) presents a challenging clinical condition of contradictory symptoms. No formal definition of DHIC exists even though many patients experience this scenario. Sacral neuromodulation (SNM) is approved for two diametrically opposed diagnoses: frequency/urgency and idiopathic non-obstructed urinary retention. We sought to evaluate the outcomes in patients with a DHIC picture who underwent SNM at our institution. METHODS A retrospective review of a prospectively-collected database was performed to identify patients with urinary urgency and a post-void residual (PVR) ≥150 (ml) on pre-operative urodynamic studies, who underwent SNM. Demographic and clinical characteristics were examined. Patients were excluded if they had diagnosis of chronic urinary retention requiring catheterization without urgency symptoms. Success was defined as clinically documented patient-perceived percent (%) improvement of ≥50% at follow-up within 4 weeks post-surgery or PVR <100. Long-term satisfaction with the procedure and Patient Global Impression of Improvement (PGI-I) were also examined. RESULTS From 6/2012-6/2017, 20 patients who underwent SNM met inclusion criteria. 3 patients did not have adequate symptom relief to progress to stage 2 SNM (15%) and 1 patient reported 0% improvement. Success rate was 80% (16/20). Demographic and clinical characteristics are shown in Table 1. Mean post-operative PVR (n=6) was 27.33 ±32.04. N=10 had data on patient-perceived % improvement and all had ≥50% improvement; 6 had >70% improvement. 7 patients had mean questionnaire follow-up of 19.3 months (range 6-30), median satisfaction of the procedure (IQR) and mean PGI-I score were 7/10 (4.5, 10.0) and 2.63 ±0.744 (range 2-4), respectively. CONCLUSIONS DHIC presents as a challenging clinical picture with contrasting patient symptoms and is difficult to treat effectively. Little data currently exists in the literature, however in our cohort of patients with simultaneous urinary urgency/frequency and incomplete emptying, SNM is a promising treatment option. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e649 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Katherine Amin More articles by this author Dena Moskowitz More articles by this author Alvaro Lucioni More articles by this author Una J Lee More articles by this author Kathleen C Kobashi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...