Sacral neuromodulation effective for treating neurogenic lower urinary tract dysfunction: NEJM
Switzerland: In the short-term, sacral neuromodulation (SNM) was shown to be effective in correcting refractory NLUTD (neurogenic lower urinary tract dysfunction) in well-selected neurologic patients, according to a study published in NEJM Evidence.
Controlling lower urinary tract function is a multilevel, complex process comprising the central and peripheral nervous system. About a million people worldwide are affected by neurogenic lower urinary tract dysfunction, which majorly impacts the quality of life and poses a considerable economic burden on health care systems. Standard treatments such as catheterization and antimuscarinics often remain unsatisfactory owing to side effects associated with their use or a lack of efficacy.
Sacral neuromodulation is a well-established treatment for non-NLUTD, but there is a shortage of randomized controlled trials showing benefits in NLUTD patients. Considering this, Martina D. Liechti, Balgrist University Hospital, University of Zürich, Zürich, Switzerland, and colleagues assessed the safety and efficacy of SNM for treating patients with NLUTD in a controlled trial.
For this purpose, the researchers recruited patients with refractory NLUTD (and intended SNM) in this sham-controlled, double-blind, multicenter trial at four Swiss SNM referral centers. Following placement of a lead in the sacral foramina S3 (rarely, S4), all patients went through SNM testing. If successful (more than 50% improvement in critical variables of bladder diary), a neurostimulator was implanted for a permanent solution.
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