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Evaluation of pre-operative bladder contractility as a predictor of improved response rate to a staged trial of sacral neuromodulation in patients with detrusor underactivity

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Abstract

Purpose

Sacral neuromodulation (SNM) is one of the few management options shown to improve outcomes in patients with detrusor underactivity (DU). This original research will investigate if preserved bladder contractility can predict a successful treatment with SNM.

Methods

This is a retrospective study of a prospectively collected database of consecutive patients with DU, who had a staged SNM trial from January 2013 to December 2018, with a minimum of 12 months follow-up. The primary outcome was the success of stage 1 SNM trial.

Results

In total, 69 patients with DU were followed. The median age was 67 [interquartile range (IQR) 74–55], median baseline bladder contractility index (BCI) 18 (IQR 67–0), and median post-void residual 200 mL (IQR 300–130). There were 35 patients (51%) that responded to a SNM trial. At a median follow-up of 23 months (IQR 39–12), three were removed for poor efficacy. In patients with detrusor acontractility (DAC), six responded (33%), compared to 29 patients (57%) with BCI > 0. This was statistically significant, p value 0.03. Younger age was also a predictive factor for SNM response, p value 0.02. There were no differences noted in those with gender, neurogenic history, previous pelvic surgery, diabetes, or pre-operative voiding history.

Conclusion

Our study showed that patients with preserved bladder contractility are more likely to respond to a trial of SNM compared with those that have DAC. Younger age was also predictive of SNM response. UDS is the only method to accurately identify DAC patients. This information will help in patient selection and pre-operative counselling.

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Abbreviations

BCI:

Bladder contractility index

DAC:

Detrusor acontractility

DU:

Detrusor underactivity

ICS:

International Continence Society

LUTS:

Lower urinary tract symptoms

OAB:

Overactive bladder

PVR:

Post void residual

SNM:

Sacral neuromodulation

UAB:

Underactive bladder

UDS:

Urodynamics

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Authors and Affiliations

  1. Department of Urology, Austin Health, University of Melbourne, 145 Studley Road, Heidelberg, VIC, 3084, Australia

    Garson Chan, Liang G Qu & Johan Gani

  2. Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, Canada

    Garson Chan

  3. Department of Urology, Western Health, University of Melbourne, Melbourne, Australia

    Johan Gani

Authors
  1. Garson Chan
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  2. Liang G Qu
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  3. Johan Gani
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Contributions

GC: project development, data collection, analysis and manuscript writing. LGQ: data analysis and manuscript writing. JG: project development, data collection, and manuscript writing.

Corresponding author

Correspondence to Garson Chan.

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Ethical approval

All procedures performed in this retrospective study involving human participants were in accordance with the ethical standards of the institutional review board of Austin Health with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Not applicable for this retrospective analysis.

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Chan, G., Qu, L.G. & Gani, J. Evaluation of pre-operative bladder contractility as a predictor of improved response rate to a staged trial of sacral neuromodulation in patients with detrusor underactivity. World J Urol 39, 2113–2119 (2021). https://doi.org/10.1007/s00345-020-03380-z

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  • DOI: https://doi.org/10.1007/s00345-020-03380-z

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