Sacral neuromodulation as a method for treating neuromuscular dysfunction of the bladder in patients with spinal cord injury: long-term results

   Objective. To study the long-term effectiveness of continuous sacral neuromodulation in patients with spinal cord injury.
   Materials and methods. From August 2020 to September 2023, 30 surgeries to install a sacral neuromodulator were performed at the neurosurgical departments of the Republican Scientific and Practical Center of Neurology and Neurosurgery together with a urologist, according to indications. Patients were divided into two groups: group 1 — 20 patients (with partially or completely preserved urination); group 2 — 10 patients (without preserved urination). In one patient from group 2, the neuromodulator was ineffective, and therefore the pulse generator was removed.
   Results. The patients were examined after 6 and 12 months: after 6 months, a questionnaire and voiding diaries were filled in; after 12 months, a comprehensive urodynamic study (CUDS) was performed, and a questionnaire and voiding diary were filled in. In patients in group 1, 6 months after the installation of a permanent SUI, the quality of life according to the SF-Qualiveen questionnaire scale improved from the initial 3.2 ± 0.7 points to 1.6 ± 0.4 points (an improvement of 50 %), and after 12 months it remained at 1.7 ± 0.3 points (an improvement of 46.8 %). In group 2 the dynamics of the indicators were less pronounced than in group 1, but the changes were also statistically significant (p < 0.05). In group 2, after 6 months, the quality of life according to the SF-Qualiveen questionnaire improved from the initial 3.5 ± 0.4 points to 2.4 ± 0.3 points (improvement by 31.4 %) and after 12 months remained at the level of 2.5 ± 0.3 points (improvement by 28.6 %). The urodynamic index maxPdet obtained during the cystometry initially and 12 months after the installation of a permanent SNM had the following dynamics: in group 1, this index decreased from 40.8 ± 12 to 32.5 ± 8.3 cm H2O (improvement by 20.3 %); group 2, this index increased from 5.8 ± 1.2 to 7.0 ± 1.1 cm H2O (improvement by 17.1 %).
   Conclusion. The quality of life of patients with neuromuscular dysfunction of the bladder after traumatic spinal cord injury after the installation of permanent neuromodulators improved in both group 1 and group 2 (p < 0.05).

1. Вишневский, Е. Л. Клиническая оценка расстройств мочеиспускания / Е. Л. Вишневский, О. Б. Лоран, А. Е. Вишневский. — М. : ТЕРРА, 2001. — 96 c.

2. Сочетанные дисфункции висцеральных органов у детей с нейрогенной дисфункцией мочевого пузыря / В. И. Морозов [и др.] // Педиатрия. Журнал им. Г. Н. Сперанского. — 2007. — Т. 86, № 6. — С. 35—40.

3. Sacral neurostimulation for urinary retention: 10-year experience from one UK center / S. N. Datta [et al.] // BJU Int. — 2008. — Vol. 101, № 2. — P. 192—196.

4. Dorsher, P. T. Neurogenic bladder / P. T. Dorsher, P. M. McIntosh // Adv. Urol. — 2012. — Vol. 2012. — P. 16.

5. Stohrer, M. The standardization of terminology in neurogenic lower urinary tract dysfunction with suggestions for diagnostic procedures / M. Stohrer // Neurourol. Urodyn. — 1999. — Vol. 18, № 2. — P. 139—158.

6. Шахпаронова, Н. В. Хронические сосудистые заболевания головного мозга: алгоритм диагностики и лечения / Н. В. Шахпаронова, А. С. Кадыков // Consilium Medicum. — 2017. — № 19 (2). — С. 104—109.

7. Fowler, C. J. The neural control of micturition / C. J. Fowler, D. Griffiths, W. C. de Groat // Nat. Rev. Neurosci. — 2008. — Vol. 9, № 6. — P. 453—466.

8. Przydacz, M. What do we know about neurogenic bladder prevalence and management in developing countries and emerging regions of the world? / M. Przydacz, P. Denys, J. Corcos // Ann. Phys. Rehabil. Med. — 2017. — Vol. 60, № 5. — P. 341—346.

9. An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD) / J. B. Gajewski [et al.] // Neurourol. Urodyn. — 2018. — Vol. 37, № 3. — P. 1152—1161.

10. Panicker, J. N. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management / J. N. Panicker, C. J. Fowler, T. M. Kessler // Lancet Neurol. — 2015. — Vol. 14, № 7. — P. 720—732.

11. Brazzelli, M., Efficacy and safety of sacral nerve stimulation for urinary urge incontinence : a systematic review / M. Brazzelli, A. Murray, C. Fraser // J. Urol. — 2006. — Vol. 175, № 3. — P. 835—841.

12. Herbison, G. P. Sacral neuromodulation with implanted devices for urinary storage and voiding dysfunction in adults / G. P. Herbison, E. P. Arnold // Cochrane Database Syst. Rev. — 2009. — Vol. 15, № 2. — P. CD004202.

13. Sacral neuromodulation for refractory lower urinary tract dysfunction: results of a nationwide registry in Switzerland / T. M. Kessler [et al.] // Eur. Urol. — 2007. — Vol. 51, № 5. — P. 1357—1363.

14. EAU guidelines on neuro-urology / B. Blok [et al.] / European Association of Urology. — 2022. — 56 p.

15. Incontinence. / P. Abrams [et al.]. — Bristol, UK : International Continence Society, 2017. — 2626 p.

16. Sacral nerve stimulation for urge incontinence and urgency-frequency. — London : National Institute for Health and Care Excellence, 2004. — 154 p.

17. Sacral neuromodulation for neurogenic lower urinary tract dysfunction : systematic review and metaanalysis / T. M. Kessler [et al.] // Eur. Urol. — 2010. — Vol. 58, № 6. — P. 865—874.

18. Averbeck, M. A. Is there a role for sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction? / M. A. Averbeck, J. Moreno-Palacios, A. Aparicio // Int. Braz. J. Urol. — 2020. — Vol. 46, № 6. — P. 891—901.

19. Averbeck, M. A. Worldwide utilization patterns of sacral neuromodulation for neurogenic lower urinary tract dysfunction / M. A. Averbeck, C. M. Gomes // Curr. Bladder Dysfunct. Rep. — 2016. — Vol. 11, № 4. — P. 356—364.

20. Clinical outcomes of sacral neuromodulation in patients with neurologic conditions / K. M. Peters [et al.] // Urology. — 2013. — Vol. 81, № 4. — P. 738—743.

21. Systematic literature review and meta-analysis of sacral neuromodulation (SNM) in patients with neurogenic lower urinary tract dysfunction (nLUTD): over 20 years’ experience and future directions / A. van Ophoven [et al.] // Adv. Ther. — 2021. — Vol. 38, № 4. — P. 1987—2006.

22. Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction: a multicenter retrospective study from China / I. Masood [et al.] // Neuromodulation. — 2021. — Vol. 24, № 7. — P. 1278—1283.

23. Spinelli, M. Latest technologic and surgical developments in using InterStimTM therapy for sacral neuromodulation: impact on treatment success and safety / M. Spinelli, K.-D. Sievert // Eur. Urol. — 2008. — Vol. 54, № 6. — P. 1287— 1296.

24. Kessler, T. M. Sacral neuromodulation for urinary retention / T. M. Kessler, C. J. Fowler // Nat. Clin. Pract. Urol. — 2008. — Vol. 5, № 12 . — P. 657—666.

25. Kessler, T. M. Prolonged sacral neuromodulation testing using permanent leads: a more reliable patient selection method? / T. M. Kessler, H. Madersbacher, G. Kiss // Eur. Urol. — 2005. — Vol. 47, № 5. — P. 660—665.

26. Wollner, J. Sacral neuromodulation. / J. Wollner, C. Hampel, T.M. Kessler // BJU Int. — 2012. — Vol. 110, № 1. — P. 146—159.

27. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study / P. E. V. van Kerrebroeck [et al.] // J. Urol. — 2007. — Vol. 178, № 5. — P. 2029—2034.

28. Сакральная нейромодуляция в лечении нервно-мышечной дисфункции мочевого пузыря у пациентов с повреждением спинного мозга: тестовая фаза / А. А. Рагузин [и др.] // Здравоохранение. Healthcare. — 2024. — № 2. — C. 53—58.

29. Sanford, M. T. Neuromodulation in neurogenic bladder / M. T. Sanford, A. M. Suskind // Transl. Androl. Urol. — 2016. — Vol. 5, № 1. — P. 117—126.

30. Эффективность сакральной нейростимуляции в лечении нейрогенной дисфункции органов таза / С. К. Акшулаков [и др.] // Нейрохирургия и неврология Казахстана. — 2020. — № 3 (60). — С. 27—39.

31. Sacral Neuromodulation for Lower Urinary Tract Dysfunction in Spinal Cord Injury : A Systematic Review and Meta-Analysis / M. Hu [et al.] // Urol. Int. — 2019. — Vol. 103, № 3. — P. 337—343.

32. Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction / M. Hohenfellner [et al.] // The Journal of Urology. — 1998 — Vol. 160, № 3. — P. 821—824.

33. Sacral neuromodulation for neurogenic lower urinary tract dysfunction / M. D. Liechti [et al.] // N. E. J. M. Evidence. — 2022. — № 1 (11). — P. 1—11.