Clinical outcomes of sacral neuromodulation in patients with neurologic conditions

To examine the outcomes in patients with and without a comorbid neurologic diagnosis (ND) or neurogenic bladder dysfunction after a staged neuromodulation procedure for refractory bladder symptoms.

Patients enrolled in our prospective neuromodulation database study were grouped according to the presence of a coexisting ND. The implantable pulse generator implant rates were evaluated. Those who had received an implantable pulse generator were further evaluated over time for complications, revisions, explantations, and reprogramming sessions collected from the medical records. The symptom changes from baseline over 2 years were measured using patient-completed voiding diaries, the Interstitial Cystitis Symptom-Problem Index, Overactive Bladder Questionnaire, the Medical Outcomes Study short form, 12-item health survey, version 2, physical and mental component subscales, and a scaled global response assessment. The data were examined using Pearson's chi-square test or Fisher's exact test, Wilcoxon rank tests, and repeated measures analyses.

Of 340 patients, 63 of 71 (88.7%) with an ND and 241 of 269 (89.6%) without an ND had an implantable pulse generator implanted (P = .82). The NDs consisted of stroke (n = 17), multiple sclerosis (n = 13), Parkinson's disease (n = 10), incomplete spinal cord injury (n = 4), cerebral palsy (n = 1), and others. The complications, revisions/explants, and reprogramming sessions were similar between the 2 groups. Statistically significant improvements were seen in both groups over time on the voiding diary variables (except for incontinence episodes and severity in the ND group), Interstitial Cystitis Symptom-Problem Index, and Overactive Bladder Questionnaire. The short form, 12-item, physical and mental component subscale scores only improved significantly in those without an ND. Most patients (>50%) in both groups reported moderate or marked improvement in overall bladder symptoms at each point using the global response assessments.

Patients with neurogenic bladder dysfunction experience benefits after neuromodulation similar to the benefits experienced by those without coexisting neurologic conditions.