Lower urinary tract sensory assessments in patients with neurogenic lower urinary tract dysfunction undergoing sacral
Stephanie A Stalder1, Stéphanie van der Lely2, Stephanie Knüpfer2
1Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland; Department of Health Sciences and Technology, ETH Zürich, 8092 Zürich, Switzerland.
Objective:
To evaluate the feasibility and outcomes of lower urinary tract electrical sensory assessment (LUTESA) in patients with neurogenic lower urinary tract dysfunction (NLUTD) undergoing sacral neuromodulation (SNM).
Methods:
Sensory evoked potentials (SEPs), current perception (CPT) and pain (PT) thresholds were assessed using repetitive electrical stimulation at four different LUT locations in 46 patients (24 female) with refractory NLUTD before and after SNM testing. Group comparisons were performed between patients with predominant storage and those with predominant voiding symptoms, with additional analysis based on clinical response to SNM (responders: ≥50 % improvement in urological symptoms).
Results:
SEP analysis revealed a prominent N1 component, with largest amplitudes for bladder dome stimulation. Descriptive analyses revealed differences between patients with voiding and storage symptoms for CPTs, PTs and SEPs. Pre/post SNM there were some changes in the N1 topography and in the transition phase (following the N1 component). SNM responders exhibited lower sensory thresholds and more distinct classical SEP waveforms already at baseline, than non-responders.
Conclusions:
LUTESA is feasible with elicitable SEPs pre/post SNM and differential manifestations for type of NLUTD. Further research on the predictive value of LUTESA for SNM success is warranted.
Significance:
LUTESA is feasible in patients with NLUTD and may help to better characterize patients for tailored treatment options.
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