[Peripheral nerve evaluation:indications, technique and results]

Area of Science:

• Neurology
• Urology
• Medical Devices

Background:

• Sacral nerve neuromodulation offers a novel treatment for chronic voiding dysfunction (CVD).
• Electrical stimulation of sacral roots aims to rebalance micturition reflexes.
• Peripheral Nerve Evaluation (PNE) is crucial for assessing sacral nerve function and patient suitability for neuromodulation.

Purpose of the Study:

• To evaluate the efficacy and safety of Peripheral Nerve Evaluation (PNE) in patients with chronic voiding dysfunction.
• To determine the role of PNE in selecting appropriate candidates for sacral nerve stimulation.
• To assess the tolerability and complication rates associated with PNE.

Main Methods:

• Performed 43 PNE procedures in 28 patients diagnosed with various forms of CVD, including Urinary Urge Incontinence (UUI), Urgency-Frequency Syndrome (UFS), Dysfunctional Voiding (DV), and mixed syndromes.
• Assessed sensory and motor responses to electrical stimulation.
• Monitored for lead migration and evaluated clinical outcomes after a period of temporary stimulation.

Main Results:

• All acute stimulations demonstrated positive sensory and motor responses.
• Premature lead migration occurred in 18.6% of PNE procedures.
• Good clinical results (>50% symptom reduction) were observed in 53.8% of UUI patients, 40% of UFS patients, 14.2% of DV patients, and 33.3% of mixed syndrome patients.
• 39.2% of patients with CVD were selected for permanent sacral nerve stimulation implantation.

Conclusions:

• PNE is an essential first step in selecting patients for sacral nerve stimulation therapy.
• PNE accurately identifies suitable candidates for permanent implantation.
• The PNE technique is easy to perform, well-tolerated, and can be conducted on an outpatient basis with minimal complications.