Short-term sacral neuromodulation sustained long-term efficacy in the management of postoperative urinary retention...

Sacral neuromodulation (SNM) serves as an effective therapeutic option for lower urinary tract dysfunction, and long-term intervention is generally required to sustain clinical benefits. Reports regarding durable therapeutic outcomes achieved with short-term SNM remain uncommon. This case indicates that short-term SNM can bring about sustained improvement of refractory non-obstructive voiding dysfunction after resection of large pelvic teratoma.

A 19-year-old female developed refractory urinary retention following excision of a huge mature cystic teratoma of the pelvis measuring 12.3 × 12.3 × 9.6 cm. Conventional conservative treatment for three months failed to relieve her symptoms. Urodynamics demonstrated reduced bladder capacity, hypersensitivity, late-filling uninhibited detrusor contractions, and a flattened voiding flow curve, with a post-void residual urine volume of 1020 mL. The patient underwent one-stage sacral neuromodulation implantation at the left S3 nerve root, with stimulation parameters set at 14 Hz, 0.6 mV and 200 μs. Spontaneous micturition returned on the first postoperative day with a single voided volume over 100 mL. During the initial six postoperative days, the average voided volume was 245 ± 76 mL, and the average daily voiding frequency was 5.5 ± 1.5 episodes. No recurrence of voiding dysfunction was observed after deactivating the stimulator. One-month urodynamic studies showed improvements in bladder capacity, though maximum flow rate remained low under study conditions. However, following stimulator deactivation, objective real-life data including a 6-day voiding diary confirmed excellent spontaneous voiding (253 mL/void, 4.5 times/day) with a post-void residual of 0 mL, showing no recurrence during the six-month follow-up.

This case suggests that short-term sacral neuromodulation can exert rapid and long-lasting effects on bladder dysfunction secondary to pelvic nerve injury, which may help reconstruct the micturition reflex and improve bladder function. The therapeutic effect could be well maintained after stimulation discontinuation and electrode removal, and no recurrence of dysuria was noted within the six-month follow-up period. This observation provides a novel reference for the treatment strategy and duration of SNM in managing urinary retention. Nevertheless, its definitive efficacy still requires verification through more clinical cases and prolonged follow-up.