Clinical study of sacral neuromodulation on non-neurogenic, non-obstructive dysuria

Objective To summarize the initial treatment experiences of SNM on non-neurogenic, non-obstructive dysuria during short follow-up. Methods From January 2013 to May, 2017, 28 patients with non-neurogenic, non-obstructive dysuria who were diagnosed by video-urodynamic study (including 20 male patients and 8 female patients; 17 patients suffered from urethra sphincter spasm and 11 from idiopathic detrusor weakness) were recruited in our study. All of them received InterStim sacral neuromodulation treatment. We tried to compare the data(such as frequency in 24 hours, residual urine, dysuria degree, nocturia, average volume and urgency) before operation and the data of short term follow-up after stage Ⅱ implanted pulse generator (IPG) embedded in order to summarize the initial experiences of sacral neuromodulation for non-neurogenic, non-obstructive dysuria. Results All 28patients received stage Ⅰ operation with percutaneous approach to implant a tined lead, 11 patients (8 male patients and 3 female patients) finally removed the tined lead because of poor testing effects. 17 patients (12 male patients and 5 female patients) choose embedding IPG at the end of stage Ⅰ. Of all these patients, the conversion rate of stage Ⅰ to stage Ⅱ is 60.7%(17/28), among them, the conversion rate of urethra sphincter spasm is 64.7%(11/17)and the conversion rate of idiopathic detrusor weakness is 54.5%(6/11). The follow-up time after stage Ⅱ was16.7 months(10-46 months). The data of voiding frequency in 24 hours, residual urine, dysuria degree, nocturia, urgency, average voiding amount and quality of life(QOL) between baseline (before stage Ⅰ) and at the follow-up time were 16.3±6.1vs.8.8±4.1(P=0.000), (43.0±73.4)ml vs.(37.8±67.1)ml(P=0.178) ; 7.8±2.3vs.4.3±1.2( P=0.001); 4.0±1.8 vs.2.5±1.7(P=0.003), 3.1±1.7vs.1.9±1.1(P=0.001), (145.7±73.5)ml vs. (189.0±66.4)ml(P=0.48), 5.7vs.1.4 (P<0.05)and 5.4±0.7vs.4.0±1.0(P=0.000), respectively. During the follow-up period, 11 patients satisfied with symptoms relieve without recurrence. Six patients had symptoms recurrence, 4/6 patients regain the effects after reprogramming, but two patients remained serious recurrence even after repeated reprogramming(frequency, dysuria and hesitation recurred as before SNM). Conclusions SNM is an effective, safe and minimally invasive procedure for patients with non-neurogenic, non-obstructive dysuria. Primary, non-neurogenic urinary sphincter spasm is a good indication for SNM and had high transfer rate. Key words: Sacral neuromodulation; Non-neurogenic, non-obstructive; Dysuria