Prospective Trial of Sacral Neuromodulation for Refractory Overactive Bladder Syndrome in Korean Patients

To evaluate the efficacy and safety of sacral neuromodulation for treating patients with refractory overactive bladder based on urodynamic data.

Patients older than 18 years of age, with overactive bladder symptoms refractory to conventional therapies were eligible. Patients with more than a 50% reduction in frequency, urgency, or urge incontinence symptoms during a 2-week test stimulation period retained the sacral neuromodulation. Voiding diaries, overactive bladder questionnaires, and urodynamic studies were performed before and 1 year after sacral neuromodulation.

Forty patients received sacral neuromodulation and 31 patients of those were followed more than 1 year. The mean age of the 31 patients was 54.2 ± 15.4 (range, 30-76) years, and the mean duration of symptoms was 4.4 ± 5.7 (range, 1-31) years. After 12 months of sacral neuromodulation, significant decreases in the episodes of daily urgency (from 20.2 to 5.7, P < 0.001), urgency incontinence (from 7.3 to 0.2; P = 0.011), day time micturition (from 21.8 to 9.9; P < 0.001), night time micturition (from 3.2 to 1.2; P = 0.006) and in severity of urgency episodes (from 3.8 to 2.7; P = 0.015) were observed compared to baseline. Significant increases occurred in bladder volume at the first unstable contraction (from 182.4 ± 92.7 to 216.8 ± 115.6 mL), bladder volume at first desire to void (from 150.5 ± 90.8 to 167.8 ± 81.5 mL), maximal cystometric capacity (from 260.7 ± 120.4 to 291.7 ± 124.3 mL) and bladder volume at urgency sensation (from 182.4 ± 92.7 to 208.2 ± 106.6 mL) (all P < 0.05).

Sacral neuromodulation is an effective and safe treatment for refractory overactive bladder.