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. 2024 Mar 15:46:e-rbgo11.
doi: 10.61622/rbgo/2024AO11. eCollection 2024.

Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital

Marcelo Mass-Lindenbaum  1   2   3 , Diego Arévalo-Vega  1   4 , Isidora Aleuanlli  5 , Fernanda Santis-Moya  1   2 , Andrea Maluenda  1   2   6 , Eitan Dines  2 , Miriam Cohen-Vaizer  7 , Álvaro Saavedra  1   2   8 , Trinidad Raby  1   2   5 , Bernardita Blumel  1   2   9 , Rodrigo Cuevas  1   2   5 , Simone Pohlhammer  1   2   10 , Gabriela Alarcon  1   2   11 , Marco Arellano Albornoz  1   2   12 , Javier Pizarro-Berdichevsky  1   2   5
Affiliations

Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital

Marcelo Mass-Lindenbaum et al. Rev Bras Ginecol Obstet. .

Abstract

Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications.

Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022.

Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I.

Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Keywords: Electric stimulation therapy; Fecal incontinence; Incontinence; Non-obstructive urinary retention; Sacral neuromodulation; Urinary bladder; overactive.

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Conflict of interest statement

Conflicts to interest: none to declare

Figures

Figure 1
Figure 1. A: Spiculated Quadripolar electrode. B: Temporary Pulse Generator. C: Implantable Pulse Generator (Interstim II)
Figure 2
Figure 2. Peripheral nerve evaluation anatomic landmarks. Insulated needle on the left and electrode already delivered on the right side
Figure 3
Figure 3. Peripheral nerve evaluation electrodes connected to the external stimulator
Figure 4
Figure 4. Lateral view of optimal electrode placement, following the sacral root from cephalad to caudal direction
Figure 5
Figure 5. Antero-posterior view of optimal electrode placement, following the sacral root from medial to lateral, at the level of the sacroiliac joint where the S3 foramina is located
Figure 6
Figure 6. IImplantable Pulse Generator in subcutaneous pocket
Figure 7
Figure 7. Flow of patients
Figure 8
Figure 8. 5 years follow up of symptomatic improvement, defined as more than 50% compared to baseline
See this image and copyright information in PMC

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