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Published on: August 28, 2020
Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral
Jonathan S Starkman1, John W Duffy, Christopher E Wolter
1Clinical Instructor, Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 MCN, Nashville, TN 37232-2765, USA. starkman137@comcast.net
Summary
Sacral neuromodulation (SNM) effectively treats refractory overactive bladder (OAB) after surgery for bladder outlet obstruction (BOO). Most patients experienced significant symptom improvement and enhanced quality of life with SNM.
Area of Science:
- Urology
- Neuromodulation
- Female Pelvic Medicine
Background:
- Refractory overactive bladder (OAB) following surgery for iatrogenic bladder outlet obstruction (BOO) presents a management challenge.
- Established treatment guidelines for this specific patient group are lacking.
Purpose of the Study:
- To evaluate the efficacy of sacral neuromodulation (SNM) in managing patients with refractory OAB after urethrolysis or sling takedown.
- To assess patient-reported outcomes, including symptom bother, satisfaction, and quality of life.
Main Methods:
- Retrospective review of eight patients who received SNM (Interstim device) for refractory OAB post-surgery.
- Two-stage implantation technique followed by subjective outcome assessment and validated questionnaires.
- Statistical analysis using Stata version 9.0.
Main Results:
- Six out of eight patients responded favorably to SNM testing and proceeded to implantation.
- All implanted patients showed significant improvement at 15.7 months follow-up; three achieved complete dryness, and three had 1-2 urgency incontinence episodes weekly.
- SNM responders reported substantial improvements in quality of life and reduced symptom bother compared to non-responders.
Conclusions:
- Sacral neuromodulation (SNM) is an effective and viable treatment option for refractory overactive bladder (OAB) in patients with a history of iatrogenic bladder outlet obstruction (BOO).
- Further research is warranted to identify predictors of SNM success and long-term durability.
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