Sacral neuromodulation effective against neurogenic lower urinary tract dysfunction: NEJM

Sacral neuromodulation (SNM) significantly treated refractory neurogenic lower urinary tract dysfunction (NLUTD) in well-selected neurologic patients in the short term, says an article published in The New England Journal of Medicine - Evidence.

Neurogenic lower urinary tract dysfunction is a common and debilitating illness; nevertheless, traditional therapies are frequently ineffective. Sacral neuromodulation is a very good treatment for non-NLUTD patients, although there are no randomized controlled trials to prove efficacy in NLUTD patients. Because excellent data from controlled studies in patients with NLUTD are few, Martina D. Liechti and colleagues investigated the effectiveness and safety of SNM in this controlled trial.

Patients with refractory NLUTD (and intending SNM) were recruited at four Swiss SNM referral facilities for this sham-controlled, double-blind, multicenter research. SNM testing was performed on all individuals following lead implantation into the sacral foramina S3 (rarely, S4). If the neurostimulator was successful (50 percent improvement in key bladder diary characteristics), it was installed for permanent stimulation. Neuromodulation was optimized for two months utilizing subsensory stimulation with specifically tailored parameters. Following that, the neurostimulator was left on or turned off for two months following neuro-urologic reassessment. The primary outcome was SNM success, as indicated above in comparison to baseline.

The key findings of this study were as follow:

1. 65 (52%) of 124 individuals who underwent SNM testing had effectively improved lower urinary tract function.

2. The intervention was allocated to 60 patients (median age, 49.5 years; 43 women) at random.

3. After two months of intervention, the SNM ON group had a success rate of 76%.

4. Despite having their neurostimulator turned off for the previous two months, 42% of patients in the SNM OFF group demonstrated lasting SNM effects.

5. There were 11 adverse events reported over the entire trial period.

In conclusion, once the testing and optimization steps were completed in our sample of carefully chosen neurologic patients, this study discovered that SNM was successful and had no device-related adverse effects. The randomized trial design not only demonstrated SNM-specific therapy benefits, but emphasized the need of ongoing SNM. Longer and larger investigations are required before the full potential of this technique can be realized.

Reference:

Liechti, M. D., van der Lely, S., Knüpfer, S. C., Abt, D., Kiss, B., Leitner, L., Mordasini, L., Tornic, J., Wöllner, J., Mehnert, U., Bachmann, L. M., Burkhard, F. C., Engeler, D. S., Pannek, J., & Kessler, T. M. (2022). Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction. In NEJM Evidence. Massachusetts Medical Society. https://doi.org/10.1056/evidoa2200071