Sacral neuromodulation outcomes in neurourological voiding dysfunction
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v81i6.828Keywords:
posterior sacral neuromodulation, neurourological voiding dysfunction, neurourological diseasesAbstract
Objective: To demonstrate the changes in the urodynamic parameters of patients with posterior sacral neuromodulation and compare these changes to their pre-implantation parameters.
Design: Observational, retrospective, comparative study of related variables. Urodynamic studies were performed on neurological patients who were candidates for posterior sacral neuromodulation (n=9). The candidates for a definitive neuromodulator underwent comparative statistical analysis using student´s t test for related samples. We evaluated on pressure-flow study: maximum flow, Pdet max, effectiveness of voiding, and compliance.
Results: Statistically significant results were found in the urodynamic measurements at peak flow (Qmax p<0.002) and in changes in detrusor pressures (p<0.001), there were no statistically significant differences found in voiding effectiveness (p=0.02).
Limitations of the study-implication: A larger number of patients are needed to compare our results to international reports, and to adjust the time of implantation after neurological lesions, since our sample was very heterogeneous.
Originality: There are no reports of sacral neuromodulation in Mexican patients exclusively with neurological disorders as described in other populations; this sample is being described as the largest population of neuromodulator carriers with neurourological diseases in Mexico.
Conclusions: In spite of not finding differences in the effectiveness of voiding in our sample, this difference is of great clinical importance since it means a decrease in or suspension of clean intermittent catheterization, which is probably also reflected in the changes of the detrusor pressures that are within the limits and has benefits for the patient as protection of the upper urinary tract and a decrease of expenses.
References
Echavarría-Restrepo L G, Gallego- Mejía A, Gómez-Londoño M, Merino-Correa S M. Efectos de las lesiones del sistema nervioso sobre la fisiología de la micción. CES Medici-na. 2019;33(3):182–91. doi: https://doi.org/10.21615/cesmedicina.33.3.3
Hamid R, Averbeck MA, Chiang H, Garcia A, Al Mousa RT, Oh SJ, et al. Epidemiolo-gy and pathophysiology of neurogenic bladder after spinal cord injury. World Journal of Urology. 2018;36(10):1517–27. doi: https://doi.org/10.1007/s00345-018-2301-z
Castro-Diaz D, Del Popolo G, Groen J, Hamid R. EAU Guidelines in Neuro-Urology. European Association of Urology; 2021.
Jairam R, Drossaerts J, Marcelissen T, van Koeveringe G, Vrijens D, van Kerrebroeck P. Predictive Factors in Sacral Neuromodulation: A Systematic Review. Urol Int. 2021 May 31;1–21. doi: https://doi.org/10.1159/000513937
Cervantes-Palma C, Campos-Salcedo JG, Mendoza-Álvarez LA, López-Silvestre JC, Díaz-Gómez C, Reyes-Equihua JL, et al. Evaluación de la eficacia, cambios en la calidad de vida y seguridad de la Neuromodulación sacra como tratamiento para pacientes con disfunción miccional en un Hospital de concentración de México. Rev Mex Urol. 2019;79(4):1–9.
Mass-Lindenbaum M, Calderón-Pollak D, Goldman HB, Pizarro-Berdichevsky J. Sacral neuromodulation - when and for who. Int Braz J Urol. 2021;47(3):647–56. doi: https://doi.org/10.1590/S1677-5538.IBJU.2021.99.08
