Sacral nerve stimulation in patients with detrusor overactivity
Yufei Chen, Prof Kate H Moore
Detrusor overactivity, particularly with symptoms of urge incontinence, can be a debilitating and embarrassing condition. Sacral nerve stimulation (SNS), or sacral neuromodulation, provides a minimally invasive treatment option for those patients refractory to conventional behavioural and anticholinergic therapy. A review was performed of major studies evaluating the use of SNS for patients with refractory urge incontinence. Factors including therapy technique, efficacy, safety and cost-effectiveness were assessed. The review showed that advances in implant technique have improved both efficacy and safety for SNS. Screening with percutaneous nerve evaluation obtains a positive response in 51-63% of patients. Of the patients that receive permanent implants with a neuromodulating device, complete dryness is obtained in 40-59% of patients and 59-76% of patients report a >50% reduction in incontinence symptoms. The most common adverse events included pain at the implant site and lead migration. A surgical revision rate of 33-51.6% to overcome adverse events was reported with up to 10% requiring permanent explantation. The cost of SNS is estimated at A$9,866 per year of patient complete dryness but long-term cost-effectiveness studies are yet to be performed. In conclusion, SNS appears to be a safe and effective option for patients with refractory urge incontinence. A more detailed cost analysis needs to be conducted before cost-effectiveness can be ascertained.