Two-Year Outcome of Percutaneous Bipolar Radiofrequency Neurotomy of Sacral Nerves S2 and S3 in Spinal Cord Injured Patients with Neurogenic Detrusor Overactivity: A Randomized Controlled Feasibility Study

Abstract

Background: Little research has been expended on the use of bipolar radiofrequency (RF) lesioning of sacral nerves in spinal cord injured (SCI) patients with neurogenic detrusor overactivity (NDO), and no study has been undertaken to demonstrate its long-term effect. Objective: To investigated the effect of bipolar RF ablation of the second and third sacral nerves over 2 years in SCI patients with NDO. Study Design: A prospective, randomized controlled feasibility study. Setting: The outpatient clinic of a single academic medical center in Korea. Methods: Ten SCI patients with NDO were recruited. These patients were randomly assigned to 2 groups; the intervention group (n = 5) and the control group (n = 5). Control group members received optimized conventional treatment. International Consultation on Incontinence Questionnaire (ICIQ), 3-day voiding diary, and the urinary incontinence quality of life scale (I-QOL) data were obtained at baseline and at 6, 12, and 24 months after intervention. Urodynamic study (UDS) was performed at baseline and 24 months after intervention. In the intervention group, percutaneous bipolar RF neurotomy was performed on both S2 and S3 nerves in each patient. Results: Frequency of urinary incontinence and ICIQ and IQOL scores showed significant effects for time and for the group x time interaction (P < 0.05). Daily mean volume of urinary incontinence showed only a significant group effect. In UDS parameters, comparisons of values at baseline and at 24 months revealed all variables showed significant intergroup differences (P < 0.05). Limitation: A small number of patients was recruited. Conclusion: Percutaneous bipolar RF ablation of sacral nerves S2 and S3 effectively reduces urinary incontinence and improves quality of life (QoL) in SCI patients with NDO and the effects lasted over 2 years. Key words: Neurogenic detrusor overactivity, bipolar RF neurotomy, sacral nerves, urinary incontinence, maximal detrusor pressure, maximum cystometric capacity