Efficacy of Sacral Neuromodulation for Symptomatic Treatment of Refractory Urinary Urge Incontinence

Objectives: To determine the efficacy and complications of sacral neuromodulation as therapy for refractory urinary urge incontinence.

Methods: Forty-one patients (mean age 54.3 +/- 15.8 years) with urge incontinence refractory to conservative therapy (ie, pharmacologic, behavioral, biofeedback therapy) were retrospectively evaluated. The patients included those who received permanent one-staged or two-staged InterStim implants. Surgical implantation of the InterStim was performed in patients who experienced a greater than 50% reduction in urge incontinence symptoms, as documented by voiding diaries during a 3 to 7-day test stimulation period.

Results: Ninety percent of patients had 50% or greater improvement in presenting symptoms and quality-of-life parameters after InterStim implantation, with a median follow-up of 12 months (interquartile range 12 to 26.5) for single-stage and 4.5 months (interquartile range 1.5 to 12) for staged implants (P = 0.0003 Wilcoxon rank-sum test). Patients with urge incontinence had a significant reduction in mean leaking episodes (from 8.8 to 2.3 per day, P = 0.0001), with a significant decrease in the mean number of pads used (from 4.7 to 0.82 per day, P < 0.0001). No patient experienced operative complications, and postoperative complications were encountered in 29% of patients.

Conclusions: Our results have demonstrated that sacral neuromodulation is a safe and effective approach for the treatment of urinary urge incontinence that is refractory to other more conservative forms of treatment.