Efficacy of sacral neuromodulation for symptomatic treatment of refractory urinary urge incontinence

Objectives. To determine the efficacy and complications of sacral neuromodulation as therapy for refractory urinary urge incontinence. Methods. Forty-one patients (mean age 54.3 +/- 15.8 years) with urge incontinence refractory to conservative therapy (ie, pharmacologic, behavioral, biofeedback therapy) were retrospectively evaluated. The patients included those who received permanent one-staged or two-staged InterStim implants. Surgical implantation of the InterStim was performed in patients who experienced a greater than 50% reduction in urge incontinence symptoms, as documented by voiding diaries during a 3 to 7-day test stimulation period. Results. Ninety percent of patients had 50% or greater improvement in presenting symptoms and quality-of-life parameters after InterStim implantation, with a median follow-up of 12 months (interquartile range 12 to 26.5) for single-stage and 4.5 months (interquartile range 1.5 to 12) for staged implants (P = 0.0003 Wilcoxon rank-sum test). Patients with urge incontinence had a significant reduction in mean leaking episodes (from 8.8 to 2.3 per day, P = 0.0001), with a significant decrease in the mean number of pads used (from 4.7 to 0.82 per day, P <0.0001). No patient experienced operative complications, and postoperative complications were encountered in 29% of patients. Conclusions. Our results have demonstrated that sacral neuromodulation is a safe and effective approach for the treatment of urinary urge incontinence that is refractory to other more conservative forms of treatment.