Predicting a successful outcome in sacral neuromodulation testing: Are urodynamic parameters prognostic?

Neurourol Urodyn. 2018 Mar;37(3):1007-1010. doi: 10.1002/nau.23383. Epub 2018 Mar 6.

Abstract

Aims: To assess whether the urodynamic parameters of mean voided volume, peak detrusor overactivity (DO) pressure, bladder compliance, capacity, and volume at first detrusor overactivity during filling cystometry can predict a successful outcome at first stage tined lead placement (FSTLP).

Methods: Ninty-nine consecutive patients with urodynamically proven idiopathic detrusor overactivity (IDO) refractory to medical treatment and opting for Sacral Nerve Stimulation (SNS), were assessed pre and post FSTLP. Data from 3-day frequency-volume charts, and patient reported (subjective) outcomes were used to assess success or failure after FSTLP. Success was defined as improvement in symptoms >50%. Binary logistic regression analysis was used to ascertain whether key parameters at filling cystometrogram were predictors for success prior to FSTLP.

Results: Binary logistic regression analysis did not demonstrate any significant relationship between the five parameters at urodynamics and outcome at FSTLP (B < 0.01, P > 0.16) for all parameters.

Conclusions: The results from this prospective analysis on patients with IDO refractive to medical therapy referred for SNS would suggest that aside from proving DO at urodynamics as a pre-requisite for intervention as per NICE and EAU guidelines, no parameter is predictive for a successful outcome at FSTLP.

Keywords: FSTLP; nerve evaluation; outcome; overactive bladder; parameters; predictive; sacral neuromodulation; success; urodynamics.

MeSH terms

  • Adult
  • Aged
  • Electric Stimulation Therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Sacrum
  • Treatment Outcome
  • Urinary Bladder, Overactive / diagnosis*
  • Urinary Bladder, Overactive / physiopathology
  • Urinary Bladder, Overactive / therapy
  • Urodynamics / physiology*
  • Young Adult