Review – Neuro-urologySacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction: Systematic Review and Meta-analysis
Introduction
The control of the lower urinary tract is a complex, multilevel process that involves both the peripheral and central nervous systems [1]. Thus, patients with neurologic disease and/or injury often suffer from lower urinary tract symptoms, which frequently have a negative impact on the patients’ health-related quality of life (QoL). The prevalence of neurogenic lower urinary tract dysfunction (LUTD) depends on the type and duration of neurologic disease and/or injury and may approach 100% (for instance, in patients with multiple sclerosis [MS]) [2]. Moreover, neurogenic LUTD is a challenge, because all available treatment modalities (ie, conservative, minimally invasive, and invasive therapies) may fail.
Sacral neuromodulation (SNM) has become a well-established and widely accepted treatment modality in recent years for patients with refractory nonobstructive chronic urinary retention, urgency–frequency syndrome, and urgency incontinence [3], [4], [5], [6]. Originally, SNM was not considered an option for neurogenic LUTD; however, some studies have suggested that SNM is also effective in this group of patients [7], [8]. Taking into account that SNM is minimally invasive and completely reversible, it is of great interest whether this treatment option is valuable for patients with neurogenic LUTD before resorting to more invasive procedures. Thus, we systematically assessed all available evidence on the efficacy and safety of SNM for the treatment of patients with neurogenic LUTD.
Section snippets
Data sources and searches
This systematic review was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement [9]. After elaboration of a review protocol, which is available upon request from the authors, we systematically searched the PubMed, EMBASE, and ScienceDirect databases (Appendix A). No language or date restrictions were applied. The last search was performed on 15 April 2010. We hand searched the reference list of all included studies and any relevant review articles.
Study selection
Search results
The flow diagram of literature searches and results is shown in Fig. 1. After screening abstracts, full-text articles, and reference lists, 34 eligible reports [7], [8], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43] were identified. Three articles [12], [31], [38] not clearly distinguishing between neurogenic and non-neurogenic LUTD and another [37]
Main findings
A pooled success rate of 68% for the test phase and of 92% for permanent SNM as well as a pooled adverse event rate of 0% for the test phase and of 24% for permanent SNM indicate that SNM may be effective and safe for the treatment of patients with neurogenic LUTD. However, although the results of this systematic review are promising, the evidence level of the included studies is generally low, and randomised, controlled trials (RCTs) are lacking.
Findings in the context of existing evidence
SNM for neurogenic LUTD has not been
Conclusions
At this time, no definitive conclusions can be drawn from the available evidence regarding the general use of SNM for neurogenic LUTD. There is evidence indicating that SNM may be effective and safe for the treatment of patients with neurogenic LUTD. However, the number of investigated patients is low, with high between-study heterogeneity, and there is a lack of RCTs. Thus, well-designed, adequately powered studies are urgently needed before more widespread use of SNM for neurogenic LUTD can
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