Evaluation of Pre-Operative Bladder Contractility as a Predictor of Improved Response Rate to a Staged Trial of Sacral Neuromodulation in Patients with Detrusor Underactivity - Beyond the Abstract

Lower urinary tract symptoms (LUTS) can severely affect patients’ quality of life (QOL). Poor bladder emptying in the form of detrusor underactivity (DU) is common, but an often overlooked cause of LUTS. Additionally, since DU is often under-recognized, patients suffer for many years before seeking appropriate treatment. However, available treatment for DU is limited by options with their own drawbacks. The main treatment is self-catheterization for poor emptying, which unfortunately reflects the unsatisfactory and insufficient available options. 



Many factors about DU remain unknown and thus, we have focused our research efforts in evaluating sacral neuromodulation (SNM) and predictors of response for these specific patients with DU. This study was the first to find that patients with any level of preserved bladder contractility on urodynamics (UDS) had significantly higher levels of response to SNM and subsequent improvement in voiding and QOL. Additionally, patients that were younger had higher response rates. Interestingly no difference between patients with a neurogenic history or if they were still voiding prior to SNM implantation predicted any difference.  
Beyond this study, we have noticed that many patients have commented on the independence and liberation from the use of catheters after SNM implantation. We feel this is important to emphasize and to advocate for further awareness of LUTS-associated DU for all clinicians. We hope our preliminary work will furthermore research and funding into SNM as a standard treatment option for those with DU. 

Written by: Garson Chan MD, FRCSC and Johan Gani MBBS, FRACS, Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia

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