A Retrospective Analysis of Sacral Neuromodulation for Vesicoureteral Reflux in Neurogenic Bladder: Outcomes and...

This retrospective study aimed to evaluate the long-term efficacy of sacral neuromodulation (SNM) in managing vesicoureteral reflux (VUR) secondary to neurogenic lower urinary tract dysfunction (NLUTD) and identified predictors of success.

A total of 26 patients with NLUTD and urodynamically confirmed VUR(21 unilateral, 5 bilateral) underwent SNM test stimulation. Video-urodynamic studies assessed VUR grade, safe bladder capacity, and detrusor pressure pre- and posttest. Success criteria were as follows: VUR reduced to grade I or lower or VUR still grade II or higher but with delayed onset of reflux and safe bladder capacity clinically judged to be suitable for clean intermittent catheterization (CIC). Patients with success proceeded to permanent implantable pulse generator placement, with annual follow-up.

During the test phase (mean 27.9 days), VUR resolved in 13 of 31 refluxing ureters. Safe bladder capacity significantly increased (119.7 ± 18.0 mL to 240.9 ±2 1.3 mL, p < 0.05) and maximum detrusor pressure during the storage phase decreased (45.0 ± 6.9 to 31.0 ± 5.9 cmH₂O, p < 0.05). A total of 21 patients received permanent implants. In 13 patients with long-term follow-up (1-4 years), VUR resolved in five patients who had persistent reflux post-test, whereas recurrence occurred in two patients. Multivariate analysis identified pretreatment VUR grade as the only significant predictor of success (odds ratio = 0.30; p < 0.05), with higher grades associated with lower odds of resolution.

SNM can improve or resolve VUR in select patients with NLUTD by enhancing bladder compliance and reducing storage pressure. Higher baseline VUR grade predicts a lower likelihood of success. Long-term success requires adherence to CIC.