Effectiveness evaluation, changes in the quality of life and safety of sacral neuromodulation as a treatment for patients with voiding dysfunction at a concentration Hospital in Mexico
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v79i4.398Keywords:
Sacral Neuromodulation, voiding dysfunction, quality of lifeAbstract
Background: Sacral neuromodulation is a minimally invasive technique to modulate spinal reflexes that influence the bladder, bowel, external urethral sphincter and pelvic floor to improve and restore voiding and evacuation functions. Its main therapeutic indications are urgency urinary incontinence, urgency-frequency syndrome, non-obstructive emptying alterations, chronic urinary retention, chronic pelvic pain, fecal incontinence and constipation. In our country there have been few studies that evaluate the efficacy and safety of this therapy.
Objetive: To evaluate the therapeutic effectiveness, safety and quality of life of patients with chronic voiding dysfunction treated with Sacral Neuromodulation at the Hospital Central Militar.
Material and Methods: From January 2010 to June 30, 2018, a review of the patient´s files treated with Sacral Neuromodulation therapy due to voiding dysfunction and who were refractory to medical treatment, to make an assessment of quality of life through employment of the instrument SF-36 v2 (Mexican version) and ICIQSF, effectiveness with the use of the results of the voiding diaries and urodynamic parameters, and the complications of the procedure were classified according to the Clavien Dindo scale. The IBM SPSS 22.0 statistical system was used.
Results: We included 41 patients in the study with the following diagnoses: detrusor-sphincter dyssynergia, overactive bladder and hypertonic urinary sphincter, located by gender (16 male and 25 female). 100% of the patients presented improvement of the symptoms with the trial phase of the therapy and a final neurostimulator was placed with the following results: more than 65% improvement in the quality of life was obtained with quantitative and qualitative parameters, as well as as in the variables of bladder capacity and post voiding volume.
Discussion and conclusions: As reported in the world literature, the results were similar in terms of effectiveness, improvement in quality of life and safety of Sacral Neuromodulation therapy. Percentages of success greater than 50% have been reported in the total cessation of incontinence episodes. Sacral neuromodulation is a minimally invasive and durable therapy for the treatment of voiding dysfunction of non-obstructive etiology. In cases in which Neuromodulation tests are not effective, this treatment has the advantage of being reversible. It is necessary to continue with the development of studies that can verify in the medium and long term, through urodynamic parameters, the efficacy of this treatment.
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