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Detailed Investigation of Bladder Diary Parameters During Sacral Neuromodulation in Patients With Overactive Symptoms

  • Sigrid Van de Borne
    Affiliations
    Department of Urology, Antwerp University Hospital, Edegem, Belgium

    Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
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  • Sam Tilborghs
    Affiliations
    Department of Urology, Antwerp University Hospital, Edegem, Belgium

    Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
    Search for articles by this author
  • Donald Vaganée
    Affiliations
    Department of Urology, Antwerp University Hospital, Edegem, Belgium

    Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
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  • Alexandra Vermandel
    Affiliations
    Department of Urology, Antwerp University Hospital, Edegem, Belgium

    Faculty of Medicine and Health Sciences, Division of Occupational and Physical Therapy, University of Antwerp, Antwerp, Belgium
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  • Stefan De Wachter
    Correspondence
    Address correspondence to: Stefan De Wachter, MD, PhD, Department of Urology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium.
    Affiliations
    Department of Urology, Antwerp University Hospital, Edegem, Belgium

    Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
    Search for articles by this author
Published:October 18, 2022DOI:https://doi.org/10.1016/j.neurom.2022.09.006

      Abstract

      Aims

      Sacral neuromodulation (SNM) is a well-accepted, minimally invasive modality for patients with overactive bladder (OAB). Successful response to SNM is defined as at least 50% improvement in key symptoms, evaluated in a bladder diary (BD). BDs provide much useful information on bladder behavior during daily life. The aim of this study is to investigate BD parameter changes during SNM therapy in patients with OAB.

      Materials and Methods

      The International Consultation on Incontinence Questionnaires (ICIQ)–BD was filled out by 34 patients with OAB, for three days at baseline and after three weeks of subthreshold sensory stimulation. The patients were considered responders for SNM when 50% improvement was seen in the BD. They underwent implantation of an internal pulse generator (IPG), and subsequently, an ICIQ-BD and a visual analog scale (VAS) evaluating bladder satisfaction during three days were filled out six weeks, six months, and one year after IPG implantation.

      Results

      IPGs were implanted in 29 patients (85%). The BD showed a significant decrease in 24-hour leakage at three weeks from 4.2 to 0.6 (−86%, p < 0.001), similar significant decreases at six weeks and six months, and at one year (−80%). Voided volume (VV) at corresponding bladder sensation codes was not different between baseline and at three weeks of tined-lead procedure (TLP) (p > 0.05), and at six weeks (p > 0.05), six months (p > 0.1), and one year of IPG (p > 0.08). After three weeks of TLP, urgency episodes decreased from 4.8 to 3.4 (−30%, p = 0.025), with 59% reduction at six-weeks IPG (p < 0.001) and 49% at six-months IPG (p = 0.013). At one year, a decrease from 4.7 to 2.3 (52% reduction, p = 0.017) was noted.
      VAS showed the strongest correlation with urgency (p < 0.001) and frequency (p = 0.006). No significant correlation was found with VV (p = 0.87).

      Conclusions

      Our study describes how bladder sensation parameters change over time in patients on SNM. VV does not significantly increase, nor does frequency significantly decrease over the first year. Leaks and the percentage of urgency episodes significantly decrease, reaching a plateau level between six-weeks and six-months SNM.

      Keywords

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