Sacral neuromodulation in Norway: clinical experience of the first three years

We present our first three years' experience of sacral neromodulation as first line therapy in patients with a non-neurogenic refractory urge incontinence. In 53 patients, 45 women and 8 men with a mean age of 54 years (range 17-76 years), tested by subacute percutan nerve evaluation, 19 patients were declared as responders according to our programme. Fourteen patients, twelve women and two men with a mean age of 47 years (range 33-73 years), agreed to implantation of a neuroprosthesis (Medtronic Interstim Model 3031), which was placed in a subcutaneous buttock pocket in 12 patients. In the first two patients, the device was implanted subcutaneously corresponding to the lower quadrants of the abdominal wall. In two patients, the lead was repositioned from S:4 to S:3 six to twelve months after the primary implantation. In one woman with sensory urgency, the neuroprosthesis was removed six months after it was implanted because of failure. The patients were followed every six months using voiding diary, uroflowmetry, residual urine and cystometry. Eight patients reported total continence, and five declared >50% improvement. One woman has chronic bacteriuria and intermittently symptomatic urinary tract infection, which reduce the response to the chronic sacral nerve stimulation. Because of residual urine, four women are following an individual self-catheterisation programme. In conclusion, we have documented that sacral neuromodulation is an effective and safe procedure in patients with refractory urge incontinence depending on detrusor overactivity. We confirm the clinical results reported by other centres with long experience of sacral neuromodulation.