Sacral Neuromodulation for Lower Urinary Tract Dysfunction in Spinal Cord Injury: A Systematic Review and Meta-Analysis

Abstract

Objective: To evaluate the intervention effect of sacral neuromodulation (SNM) in the treatment of lower urinary tract dysfunction after spinal cord injury (SCI).

Methods: We selected relevant studies published between January 1, 1971 and November 15, 2018 by searching the PubMed, EMBASE, Cochrane databases. The outcome was assessed as follows: patients who had at least 50% improvement in bladder diary variables (number of leakages, pad use, number of voids, number of catheterizations, and so on). All analyses were performed with R software (version 3.5.1). We used Cochran's Q test and I2 statistics to evaluate the heterogeneity.

Results: A total of 8 articles met all inclusion criteria for the systematic review. According to the Oxford Centre for Evidence-Based Medicine hierarchy, the evidence levels ranged from 2b to 4. During the test phase of SNM, we considered 108 patients. During the test phase, the merged success rate was 45% (95% CI 36-55%, p = 0.23, I2 = 31%). Overall, 99 patients were considered during the permanent implantation phase of SNM; the mean follow-up time ranged from 8.4 to 61.3 months, and the merged success rate of the permanent SNM phase was 75% (95% CI 64-83%, p = 0.46, I2 = 0%). All the reported adverse events were resolved.

Conclusions: Based on current evidence, the success rate of the test phase of SNM for LTUD in SCI patients was low, but in the permanent phase, the success rate of SNM was optimistic. In the future, well-designed randomized controlled trial with adequate sample sizes and power are necessary to validate the efficacy and safety of SNM.

Keywords: Lower urinary tract dysfunction; Meta-analysis; Sacral neuromodulation; Spinal cord injury.