Benjamin J. Coons, Cory D. Harris, Jonathan S. Starkman, Harriette M. Scarpero, Douglas F. Milam

Department of Urology, Vanderbilt University, Nashville, TN, USA

Introduction and Objectives: Sacral neuromodulation is currently indicated for the treatment of medically refractory urgency/frequency syndromes, urinary urge incontinence, and non-obstructive urinary retention (NUR). We evaluated our experience with sacral neuromodulation in the management of men with NUR.

Methods: We performed a retrospective chart review of all the patients who had undergone placement of the Interstim® device at Vanderbilt University from June 2002 to July 2006 and identified 12 men with a diagnosis of non-obstructive urinary retention. Four patients with documented neurologic disease were excluded, leaving 8 patients that form the cohort of this study. All patients underwent a peripheral nerve evaluation (PNE) in the GU clinic and those who responded with either 1) a decrease in catheterization volume or 2) decreased frequency of clean intermittent catheterization (CIC) or 3) those who reported a ≥ 50% subjective improvement in their voiding ability underwent placement of an implantable pulse generator (IPG). Clinical, surgical, urodynamic, and postoperative data was collected for all patients and outcomes determined based upon clinical response following PNE and IPG placement.

Results: During this four year period, 8 neurologically intact men with NUR underwent test stimulation via PNE. Average patient age was 58 (range 37-77) and mean preoperative post-void residual (PVR) was 550 ml (range 244-1200). Average Pdet@Qmax was 39 cm H2O (23-53) at an average Qmax was 4.4 ml/sec (0-6). Two of our eight patients (25%) showed objective improvement with a PVR less than 50ml and discontinuation of CIC following IPG placement. Four patients (50%) demonstrated short-term improvement in catheterization frequency and PVR volumes that did not persist with long term follow-up. Two patients (25%) did not undergo placement of the IPG, due to lack of subjective or objective improvement during the test-stimulation period. Thus, overall response to PNE was 6/8 (75%) while durable response following IPG placement was 2/6 (33%).

Conclusion: In our small experience, male patients with NUR rarely demonstrate objective improvement in their urinary retention. The long-term improvement in 33% of those who had the IPG placed when compared to the initial 75% response rate to PNE suggests that a staged procedure with a longer trial period may be more effective in predicting those who would benefit from IPG placement. Utilization of objective rather than subjective parameters to more appropriately select patients will guide a future prospective trial in this patient population.

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