Efficacy and Safety of Sacral Neuromodulation on Patients With Multiple Sclerosis and Lower Urinary Tract...

Treating multiple sclerosis (MS)-related adult neurogenic lower urinary tract dysfunction (ANLUTD) is challenging because conservative treatments are often ineffective. Sacral neuromodulation (SNM) is a promising minimally invasive treatment of ANLUTD. This review assesses the efficacy and safety of SNM for MS-related ANLUTD.

Studies were identified through electronic searches of PubMed and Scopus from inception to August 9, 2024, supplemented by backward and forward manual searches. All studies included were original articles investigating the impact of SNM on urinary symptoms in patients with MS and ANLUTD. Three independent reviewers assessed the quality of evidence using the Oxford Centre for Evidence-Based Medicine criteria and the ROBINS-I tool.

Seventeen studies involving 192 patients with MS undergoing SNM were included. The analysis revealed overall success rates of 80% (95% CI, 76%-91%) and 74% (95% CI, 62%-86%) for the test phase (stage I) and permanent SNM (stage II), respectively. Subgroup analyses explored limitations and potential sources of heterogeneity, including gender and type of urinary dysfunction, offering deeper insight into the effectiveness of SNM. With respect to safety, the pooled incidence of complications was approximately 7%, the majority of which were minor and manageable.

This systematic review highlights the potential of SNM to improve urinary symptoms in patients with MS-related ANLUTD, although the quality of evidence remains low. Further adequately powered randomized clinical trials are needed to clarify long-term efficacy and safety.