Successful Implantation of Sacral Neurostimulator in a Kidney Transplant Recipient Due to Neurogenic Hypocontractile Bladder

Abstract

Impaired bladder emptying and urinary retention due to hypocontractile bladder negatively affect renal function in kidney transplant recipients. Conservative and medical treatment options might have short-term beneficial effects; however, in a substantial number of patients the effectiveness of these therapies is disappointing. Most of the patients end with intermittent self-catheterisation. We present a case of a 61-year-old male patient that presented with symptoms of voiding dysfunction 4 years after kidney transplantation. Sonographic assessment revealed a residual volume of 386 ml. After having a TUR-P procedure for suspected prostate hyperplasia, no change in post-mictionary residual volume could be observed. An video-urodynamic evaluation showed a hypocontractile bladder with maximum Pdet = 23 cmH2O. Neurologic assessment showed two episodes of herniated vertebral discs in the past patient history. After failure of conservative treatment, indwelling catheterisation was necessary, which resulted in recurrent lower urinary tract infections sand two episodes of transplant PN. The patient was offered sacral neurostimulation (SNM) as a treatment option. During test stimulation, he experienced a striking improvement in voiding dysfunction with residual urinary volumes between 90-120ml. He then underwent a one-stage implantation of a sacral neurostimulator (Medtronic®) without adverse events. In particular, no infections or rejections have occurred during the first 30 days after the implantation. The maintenance immunosuppression was not interrupted. After 9 months' follow-up, the sonographic residual bladder volume is averagely 75ml. The results of this report suggest that sacral neurostimulator might be useful in treatment of voiding dysfunction in NTx patients in order to protect the transplant graft from recurrent urinary infections.