Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease.

Abstract

Retrospective case series. The primary aim was to assess the clinical effects of sacral neuromodulation (SNM) for neurogenic bladder and/or bowel dysfunction with multiple symptoms secondary to spinal cord disease or injury. Beijing, China. Between 2011 and 2013, 23 patients with multiple bladder and/or bowel problems secondary to spinal cord disease or injury were treated with a preliminary test SNM. If at least 50% clinical improvement occurred, then the patient underwent a permanent SNM procedure. We evaluated the patients using a bladder diary, post-void residual volume measurement and the Wexner questionnaire score for constipation before the test phase, during the test phase and after the permanent SNM. In the test phase, the rate of improvement in dysuria (29.4%) was significantly lower than urgency frequency (64.7%), urinary incontinence (69.2%) and constipation (75.0%). An implant was performed in 13 (56.5%) patients, including 4 patients who still used intermittent catheterization to exclude urine after permanent SNM because the symptom of dysuria could not be improved significantly and 1 patient who achieved ⩾50% improvement in lower urinary tract dysfunction but not in constipation. During follow-up (17.5±2.0 months), 1 patient (7.7%) failed and 1 patient had bilateral vesicoureteral reflux. Chronic SNM cannot always resolve all the bladder and bowel symptoms secondary to spinal cord disease or injury, but combined with other treatments may help improve multiple symptoms.