NEW YORK (Reuters Health) - Sacral neuromodulation appears to be a safe and effective treatment for urinary urge incontinence unresponsive to pharmacologic agents, biofeedback, and other conservative therapies, according to a new report.

Sacral neuromodulation involves chronic stimulation of the sacral nerves with an implanted electrode and a battery-powered pulse generator. Exactly how this therapy works is unclear, but several reports have shown a therapeutic benefit for urge incontinence.

In the present study, reported in the March issue of Urology, Dr. Jerilyn M. Latini, from the University of Michigan in Ann Arbor, and colleagues assessed the outcomes of 41 patients with refractory urinary urge incontinence who underwent a one- or two-stage InterStim (Medtronic) implant procedure.

As the investigators explain, some patients with average body habitus underwent percutaneous test stimulation for a few days before permanent InterStim implantation. Other patients who were not candidates for percutaneous testing or failed this approach underwent a two-stage procedure. That is, the permanent electrode was implanted and attached to an external stimulator, and if this successfully alleviated symptoms a permanent device was implanted.

During median follow-up periods of 4.5 months for two-staged implants and 12 months for one-staged implants, 90% of the patients experienced 50% or greater improvements in presenting symptoms and quality of life, the report indicates (p = 0.0003).

Sacral neuromodulation was also associated with a drop in the mean number of leaking episodes from 8.8 to 2.3 per day (p = 0.0001). At the same time, the number of pads used per day fell from 4.7 to 0.82 (p < 0.0001).

No operative complications were noted, but 29% of patients experienced postoperative complications, most commonly a superficial wound infection that resolved with antibiotics.

"Sacral neuromodulation using InterStim therapy is safe, minimally invasive, and reversible," the authors conclude. "It does not carry the risk of systemic side effects such as with pharmacologic therapy or the potential morbidity that open surgical procedures may carry."

Urology 2006;67:550-554

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