Transverse myelitis with urinary retention and clean, intermittent catheterization treated with neuromodulation

Transverse myelitis is a chronic, debilitating neurologic disease with numerous urological manifestations, including urinary detrusor overactivity, detrusor sphincter dyssynergia and urinary retention. We review our results with sacral neuromodulation for urinary retention in female patients with transverse myelitis.

A retrospective, observational study was conducted among female patients with transverse myelitis and urinary retention hospitalized between January 2002 and January 2009. Five of seven consecutive women underwent Stage 1 and 2 sacral neuromodulation under general anesthesia.

Four ambulatory patients (57%) were successfully implanted, while three nonambulatory patients did not achieve implantation, with a mean follow-up of 3.87 +/- 2.11 years and mean postoperative postvoid residual of 72.5 +/- 45.6 mL (p < 0.001). Postoperative uroflowmetry revealed a mean maximum uroflow of 16.7 +/- 5.9 mL/sec (preoperative max flow was 0.0 mL/sec) (p < 0.001). Two implanted patients required revisional surgeries for lead migration and increased impedance.

Ambulatory female patients with transverse myelitis and urinary retention may be successfully treated with sacral neuromodulation. Insignificant improvements in postvoid residual urine/maximum uroflow were attained with nonambulatory and assisted ambulatory patients.