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Sacral Neurostimulation in Neurogenic Lower Urinary Tract and Bowel Dysfunction Caused by Multiple System Atrophy
André Reitz1, Axel Haferkamp2, Christian Gilfrich3
1KontinenzZentrum Hirslanden, Zurich, Switzerland.
Neurourology and Urodynamics
|June 5, 2025
Summary
Sacral neuromodulation (SNM) offers temporary relief for lower urinary tract dysfunction (LUTD) and bowel symptoms in advanced Multiple System Atrophy (MSA). Long-term efficacy varied, with some patients eventually needing suprapubic tubes.
Area of Science:
- Neurology
- Urology
- Gastroenterology
Background:
- Multiple system atrophy (MSA) is a progressive neurodegenerative disorder impacting autonomic, motor, and cerebellar systems.
- Lower urinary tract dysfunction (LUTD) and bowel symptoms are common and often refractory to conservative treatments in advanced MSA.
Purpose of the Study:
- To evaluate sacral neuromodulation (SNM) as a treatment for LUTD and bowel dysfunction in patients with advanced MSA.
Main Methods:
- A retrospective case series of eight patients with refractory LUTD and bowel symptoms.
- Urodynamic evaluations and percutaneous sacral nerve test stimulation at S3/S4 roots.
- Assessment of symptom reduction via bladder diaries over an 8-day test phase and long-term follow-up.
Main Results:
- Seven patients proceeded to permanent SNM implantation.
- Six patients achieved ≥50% LUT symptom reduction at 2 months post-implantation, with sustained relief in 36 of 44 visits over a median 35-month follow-up.
- SNM efficacy diminished over time, and bowel symptom management was variable, with some patients experiencing improvement in defecation.
Conclusions:
- Sacral neuromodulation (SNM) provides temporary relief for LUTD and bowel symptoms in advanced MSA.
- Further research is needed to optimize patient selection and stimulation parameters for long-term management.
