Melissa R. Kaufman, Cory D. Harris, Jonathan S. Starkman, Douglas F. Milam, Harriette M. Scarpero, and Roger R. Dmochowski

Department of Urologic Surgery, Vanderbilt University, Nashville, TN

Introduction and Objectives: Management of complex voiding dysfunction following hysterectomy with sacral neuromodulation represents an expanding indication for this promising treatment modality. Herein we describe our experience treating women with voiding complaints related to surgical hysterectomy with sacral nerve stimulation (SNS).

Methods: A retrospective review of the Vanderbilt Sacral Neuromodulation Database was performed to identify patients who presented with voiding conditions whose onset corresponded to the time of their hysterectomy. Patient charts were evaluated for demographics, presenting symptoms, medical management regimens, urodynamic findings, and results from implantation of SNS including postoperative complications.

Results: Nine patients were identified that presented with voiding symptoms temporally associated with prior hysterectomy. Average patient age was 43 years (range 38 - 51 years). Five patients (63%) presented with findings of nonobstructive urinary retention. Two of these patients with retention had superimposed symptoms of urgency-frequency. The remaining 4 patients had diagnoses of urgency-frequency. Average duration of symptoms prior to presentation was 2.6 years (range 1 - 4 years). All patients with urinary retention were treated with clean intermittent catheterization prior to successful neuromodulator test response and subsequent SNS generator implantation. Patients with urgency-frequency were given a trial of anticholinergic medication preceding surgical intervention. There were no consistent urodynamic findings predicting success with SNS. Average length of follow up was 11 months (range 1 – 37 months). 4 patients had minor complications of wound infections, with 3/9 (33%) requiring lead revision or replacement of the SNS device. 7/9 patients (78%) recorded considerable subjective improvement (>90%) in voiding symptoms following neuromodulation with the remaining two patients reporting minimal or no improvement. Although 4/5 (80%) of the urinary retention patients indicated symptom improvement, 60% also continued to utilize clean intermittent catheterization at least once daily at last follow up. Only one patient remained on anticholinergic medications postoperatively and aside from revisions of the neuromodulator, no patient underwent further urologic surgeries for their voiding symptoms.

UroToday.com Coverage of SUFU 2007

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