Effect of sacral neuromodulation in patients with neurogenic bladder

Abstract Background: Sacral neuromodulation (SNM) is widely used in patients with non-neurogenic overactive bladder and urinary retention but has only been applied recently for the management of the neurogenic bladder, and data are still scarce. Methods: This was a case series of patients who met the diagnosis of neurogenic bladder and received SNM between January 2016 and April 2019. Each participant received SNM. The evaluation of the participants' quality of life and urination diary (bladder symptom tracking form) included urine leaks, if urine pads need to be changed, urgent urination (0-5 points), urinary catheterization, and urinary output. The participants' expected values were analyzed. An effect >50% was considered effective. Results: All participants complied with the preoperative perineal floor exercise training. Among the 14 participants who underwent phase I SNM, one had no response at all and was excluded. After permanent electrode implantation, the urine output of one participant was similar to that of before surgery, and one participant had an incision infection, and the electrode was eventually removed. The postoperative follow-up after stage II SNM was 7.5±2.1 (range, 5-12) months. All 11 patients showed significant improvements in numbers of urination, urgency score, residual volume, and urination volume. The postoperative NEWS pain score was 1.6±0.9. Conclusions: Two-stage SNM can achieve satisfactory results in patients with neurogenic bladder. The key to success might lie in the correct and effective nursing and guidance throughout the perioperative management.