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Long-term Efficacy And Safety Of Neuromodulation For Refractory Urgency/frequency
Stanley Zaslau, Douglas Maxey*, Scott Sparks*, Adam Perlmutter*, Dale Riggs*, Barbara Jackson*, Stanley Kandzari
West Virginia University, Morgantown, WV

Introduction: Sacral neuromodulation (Interstim) is an FDA-approved treatment modality for refractory urgency/frequency, refractory urgency incontinence, and non-obstructive urinary retention. The purpose of this study is to present the authors’ experience with this procedure by prospectively evaluating the first 53 patients with refractory urgency/frequency with two-year follow up.
Methods: The first 53 patients who underwent successful Stage II sacral neuromodulation were followed prospectively. All patients underwent upper tract evaluation, cystoscopy, and urodynamic evaluation before the Interstim Stage I procedure. Patients were deemed eligible for Stage II implantation if they demonstrated at least a 50% improvement in urinary frequency, urgency, and urgency incontinence.
Results: The study group consisted of two male and 51 female patients; their mean age was 51 years. All patients had refractory urgency/frequency. At two years, 40 of 53 (75%) patients with refractory urgency/frequency were similarly improved as compared with immediately post-Stage II implant. Urinary frequency improved from a mean of 21 voids/day pre operatively to 8 voids/day at two year follow up. Nocturia improved from 4.77 voids/night pre operatively to 1.42 voids/night at 2 year follow up. Ten of 53 (18%) of patients required revision during the two-year post- implant period. Three (6%) patients required device removal due to infection of the IPG site.
Conclusions: Sacral neuromodulation appears to be a safe and efficacious treatment for refractory urgency/frequency and non-obstructive retention. Success appears to be durable at two-year follow up. However, revisions are likely during the post-implant period with a low infection rate.

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