Enter your Email address:
Wolters Kluwer Health may email you for journal alerts and information, but is committed
to maintaining your privacy and will not share your personal information without
You currently have no recent searches
Ward, R. M.; Biller, D. H.; McPheeters, M. L.; Hartmann, K. E.
Obstetrics & Gynecology, Vanderbilt University Medical Center, Nashville, TN
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: None.
To systematically review and synthesize published literature on sacral neuromodulation for the treatment of urinary urgency, frequency and urge urinary incontinence.
Vanderbilt University's Evidence-based Practice Center was contracted by the Agency for Healthcare Research and Quality to review the literature on the Management of Overactive Bladder, including sacral neuromodulation. Literature published in English from January 1966 to October 2008 and indexed in PubMed, MEDLINE®, EMBASE and CINAHL were included. All references from key articles were hand-searched to identify additional studies. Two reviewers separately evaluated each abstract to evaluate for inclusion or exclusion. Articles selected for inclusion were then reviewed in full by two reviewers to determine if inclusion criteria were met. Discordance was resolved by third-party adjudication. Studies with fewer than 50 participants were excluded, as were studies with less than 75% women or a lack of relevance to overactive bladder.
Eleven studies on sacral neuromodulation met inclusion criteria: one RCT, two prospective cohorts, and eight case series. Study designs were generally weak, with six of the studies involving subject duplication from multiple sites. Seven of the studies did not restrict the study population to overactive bladder, compromising generalizability. The one RCT demonstrated a statistically significant benefit for sacral neuromodulation over usual care for the reduction of episodes of incontinence per day (average reduction of 7.1 episodes compared to a 2.1 increase among subjects who had failed medical management). Six case series reported a decrease in urge incontinence episodes of 51% to 80% daily. The length of follow-up ranged from six months to five years. Urinary frequency decreased between 31% and 45% consistently across all of the studies, regardless of study design; with most follow up ranging 6 to 24 months. One prospective case series found a 33% decrease in mean voids per day at one year, dropping to a 23% decrease at 5 years. Three studies found an increase in the mean voided volume of 78 to 108 mL per void. Two studies found that sacral neuromodulation had a beneficial effect on quality of life. In the early studies, there was an average of 1.1 to 1.7 adverse events per participant. Advances in technology have decreased this rate and more recent studies report 0.1 to 0.5 events per participant. Pain, lead migration or problems with the lead, infection and explantation of the device were the most common adverse events. Pain at the implantable pulse generator site occurred in 15.4% to 27% of the cases. Infection occurred in 1.9% to 6.1% of participants.
Sacral neuromodulation can provide modest improvement in rates of urinary frequency and urge incontinence, and in some instances improves quality of life. Additional research is needed to establish the circumstances under which sacral neuromodulation is an appropriate treatment choice, and to address whether the higher rate of adverse events seen with these techniques is outweighed by the symptom benefit.
Overactive bladder; Sacral Neuromodulation Therapy; literature review
© 2010 by Wolters Kluwer Health | Lippincott Williams & Wilkins
Colleague's E-mail is Invalid
Your Name: (optional)
Separate multiple e-mails with a (;).
Thought you might appreciate this item(s) I saw at Female Pelvic Medicine & Reconstructive Surgery.
Send a copy to your email
Your message has been successfully sent to your colleague.
Some error has occurred while processing your request. Please try after some time.
An Existing Folder
A New Folder
The item(s) has been successfully added to "".
Login with your LWW Journals username and password.
Username or Email:
Enter and submit the email address you registered with. An email with instructions to reset your password will be sent to that address.
Link to reset your password has been sent to specified email address.
What does "Remember me" mean?
By checking this box, you'll stay logged in for
days or until you logout. You'll get easier access to your articles, collections,
media, and all your other content, even if you close your browser or shut down your
To protect your most sensitive data and activities (like changing your password),
we'll ask you to re-enter your password when you access these services.
What if I'm on a computer that I share with others?
If you're using a public computer or you share this computer with others, we recommend
that you uncheck the "Remember me" box.
Save my selection
Highlight selected keywords in the article text.
Search for Similar Articles
You may search for similar articles that contain these same keywords or you may
modify the keyword list to augment your search.