Management of non-neurogenic, non-obstructive dysuria represents one of the most challenging dilemmas in urological practice. The main clinical symptom is the increase in residual urine. Voiding dysfunction is the main cause of dysuria or urinary retention, mainly due to the decrease in bladder contraction (the decrease in contraction amplitude or duration) or the increase in outflow tract resistance. Sacral neuromodulation (SNM) has been used for > 10 years to treat many kinds of lower urinary tract dysfunction. It has become increasingly popular in China in recent years. Consequently, studies focusing on non-neurogenic, non-obstructive dysuria patients treated by SNM are highly desirable.
To assess the outcome of two-stage SNM in non-neurogenic, non-obstructive dysuria.
Clinical data of 54 patients (26 men, 28 women) with non-neurogenic, non-obstructive dysuria treated by SNM from January 2012 to December 2016 in ten medical centers in China were retrospectively analyzed. All patients received two or more conservative treatments. The voiding diary, urgency score, and quality of life score before operation, after implantation of tined lead in stage I (test period), and during short-term follow-up (latest follow-up) after implantation of the implanted pulse generator in stage II were compared to observe symptom improvements.
Among the 54 study patients, eight refused to implant an implanted pulse generator because of the unsatisfactory effect, and 46 chose to embed the implanted pulse generator at the end of stage I. The conversion rate of stage I to stage II was 85.2%. The average follow-up time was 18.6 mo. There were significant differences between baseline (before stage I) and the test period (after stage I) in residual urine, voiding frequency, average voiding amount, maximum voiding amount, nocturia, urgency score, and quality of life score. The residual urine and urgency score between the test period and the latest follow-up time (after stage II) were also significantly different. No significant differences were observed for other parameters. No wound infection, electrode breakage, or other irreversible adverse events occurred.
SNM is effective for patients with non-neurogenic, non-obstructive dysuria showing a poor response to traditional treatment. The duration of continuous stimulation may be positively correlated with the improvement of residual urine.
World journal of clinical cases. 2020 Jul 26 [Epub]
Ling-Feng Meng, Wei Zhang, Jian-Ye Wang, Yao-Guang Zhang, Peng Zhang, Li-Min Liao, Jian-Wei Lv, Qing Ling, Zhong-Qing Wei, Tie Zhong, Zhi-Hui Xu, Wei Wen, Jia-Yi Li, De-Yi Luo
Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China., Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China. ., Department of Urology, Beijing Chaoyang Hospital, Institute of Urology, Capital Medical University, Beijing 100000, China., Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing 100000, China., Department of Urology, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China., Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China., Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China., Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China., Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou 310000, Zhejiang Province, China., Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China., Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China., Department of Urology, West China Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China.