OBJECTIVES: To investigate changes in urinary nerve growth factor (uNGF) in women with symptomatic detrusor overactivity (DO) following peripheral nerve evaluation for sacral neuromodulation versus controls.
STUDY DESIGN: 23 subjects with overactive bladder (OAB) symptoms and DO who failed management with anticholinergics and 22 controls consented to participate in this prospective pilot study. Urine specimens were collected from controls at baseline for evaluation of uNGF and creatinine (Cr). Subjects were evaluated at baseline and 5 days after a trial of sacral nerve stimulation referred to as a peripheral nerve evaluation (PNE). Each visit included urine collection for uNGF and Cr, Incontinence Quality of Life Questionnaire (I-QOL), Urinary Distress Inventory Questionnaire (UDI-6), post-void residual volume, and a 3-day voiding diary. uNGF levels were measured by ELISA and expressed as uNGF pg/Cr mg.
RESULTS: Subjects with DO had significantly higher baseline uNGF levels (corrected for creatinine) compared to controls (19.82pg/mg vs. 7.88pg/mg, p< 0.002). Seventeen DO subjects underwent PNE and were evaluated at the end of the testing period. There was a significant improvement in quality of life scores for subjects after PNE compared to baseline (UDI-6: 7.0 vs. 13.7, p< 0.001; I-QOL: 87.3 vs. 52.8, p< 0.0001). Concordantly, uNGF levels significantly decreased from 17.23pg/mg to 9.24pg/mg (p< 0.02) after PNE.
CONCLUSIONS: uNGF levels decrease with symptomatic response in DO subjects undergoing PNE. DO Subjects had significantly higher uNGF at baseline versus controls, and uNGF levels significantly decreased after only 5 days of sacral nerve stimulation. These findings support a larger study to validate the use of uNGF as an objective tool to assess therapeutic outcome in patients undergoing PNE for sacral neuromodulation.
Written by:
Shalom DF, Pillalamarri N, Xue X, Kohn N, Lind LR, Winkler HA, Metz CN. Are you the author?
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, North Shore - Long Island; Jewish Health System, Great Neck, New York 11021; Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, New York 11030; Biostatistics Unit, The Feinstein Institute for Medical Research, Manhasset, New York, 11030.
Reference: Am J Obstet Gynecol. 2014 Jul 11. pii: S0002-9378(14)00689-9.
doi: 10.1016/j.ajog.2014.07.007
PubMed Abstract
PMID: 25019486
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