Unilateral versus bilateral sacral neuromodulation in patients with chronic voiding dysfunction.

Area of Science:

• Urology
• Neuromodulation
• Pelvic Floor Disorders

Background:

• Chronic voiding dysfunction affects numerous patients, impacting quality of life.
• Sacral nerve neuromodulation is a treatment option for refractory voiding issues.
• Bilateral sacral neuromodulation has been proposed as a potentially more effective approach than unilateral stimulation.

Purpose of the Study:

• To compare the efficacy of bilateral versus unilateral sacral neuromodulation for chronic voiding dysfunction.
• To investigate potential advantages of bilateral sacral neuromodulation.
• To evaluate patient outcomes in a randomized crossover trial.

Main Methods:

• A prospective randomized crossover trial involving 33 patients with chronic voiding dysfunction.
• Patients received temporary bilateral lead implantation for both unilateral and bilateral test stimulation.
• Voiding diaries and sacral x-rays were used to assess outcomes and lead placement.

Main Results:

• A statistically significant improvement in voiding parameters was observed during the test stimulation period.
• No statistically significant difference in efficacy was found between bilateral and unilateral stimulation overall.
• Two patients with urinary retention experienced improved voiding to completion exclusively with bilateral stimulation.

Conclusions:

• Bilateral sacral neuromodulation is not generally superior to unilateral stimulation for chronic voiding dysfunction.
• Individual patient responses may vary, with some benefiting more from bilateral stimulation.
• Consider a bilateral sacral nerve stimulation test if unilateral percutaneous nerve evaluation proves insufficient.