Efficicacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review

Miriam Giovanna Brazzelli, Alison Catherine Murray, Cynthia Mary Fraser

Research output: Contribution to journalArticle

185 Citations (Scopus)

Abstract

Purpose: We systematically reviewed the evidence on the efficacy and safety of sacral nerve stimulation (SNS) for severe urge incontinence.

Materials and Methods: A systematic review was performed of primary studies of SNS for urge incontinence published in English between 1966 and May 2003, and identified in major electronic databases. Two reviewers independently selected studies, assessed their methodological quality and extracted data.

Results: Four randomized controlled trials and 30 case series were identified. Evidence from the randomized controlled trials, involving approximately 120 patients, showed that; about 80% achieved continence or greater than 50% improvement in their main incontinence symptoms after SNS compared with about 3% of controls receiving conservative treatments while waiting for an implant. While case series were larger, they were methodologically less reliable. However, they showed similar results with 67% of patients becoming dry or achieving a greater than 50% improvement in symptoms after implantation. Incontinence episodes, leakage severity, voiding frequency and pad use were significantly lower after implantation. Benefits were reported to persist 3 to 5 years after implantation. Adverse events were documented in 27 studies. Overall the reoperation rate in implanted cases was 33%. The most common reason for surgical revision was relocation of the generator because of pain and infection. Common complications were pain at the implant or lead site in 25% of patients, lead related problems such as lead migration in 16%, replacement and repositioning of the implanted pulse generator in 15%, wound problems in 7%, adverse effects on bowel function in 6%, infection in 5% and generator problems in 5%. Permanent removal of the electrodes was reported in 9% of patients. Technical changes with time have been associated with decreased complication rates.

Conclusions: There is evidence indicating that SNS is effective for decreasing symptoms in patients with urge incontinence. Adverse events occurred in about half of the implanted cases and surgical revision was performed in 33%. No major irreversible complications were reported in the studies reviewed. Further research is required on the long-term effects of and quality of life in patients with SNS.

Original languageEnglish
Pages (from-to)835-41
Number of pages7
JournalJournal of Urology
Volume175
Issue number3/1
DOIs
Publication statusPublished - 2006

Keywords

  • bladder
  • urinary incontinence
  • prostheses and implants
  • electric stimulation
  • equipment safety
  • IMPLANTATION TECHNIQUE
  • ROOT NEUROMODULATION
  • OVERACTIVE BLADDER
  • MULTICENTER
  • DYSFUNCTION
  • RETENTION
  • DIARY

Cite this

Efficicacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. / Brazzelli, Miriam Giovanna; Murray, Alison Catherine; Fraser, Cynthia Mary.

In: Journal of Urology, Vol. 175, No. 3/1, 2006, p. 835-41.

Research output: Contribution to journalArticle

Brazzelli, Miriam Giovanna ; Murray, Alison Catherine ; Fraser, Cynthia Mary. / Efficicacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. In: Journal of Urology. 2006 ; Vol. 175, No. 3/1. pp. 835-41.
@article{7359f2d2fba84b0ca55d3dff23eae361,
title = "Efficicacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review",
abstract = "Purpose: We systematically reviewed the evidence on the efficacy and safety of sacral nerve stimulation (SNS) for severe urge incontinence.Materials and Methods: A systematic review was performed of primary studies of SNS for urge incontinence published in English between 1966 and May 2003, and identified in major electronic databases. Two reviewers independently selected studies, assessed their methodological quality and extracted data.Results: Four randomized controlled trials and 30 case series were identified. Evidence from the randomized controlled trials, involving approximately 120 patients, showed that; about 80{\%} achieved continence or greater than 50{\%} improvement in their main incontinence symptoms after SNS compared with about 3{\%} of controls receiving conservative treatments while waiting for an implant. While case series were larger, they were methodologically less reliable. However, they showed similar results with 67{\%} of patients becoming dry or achieving a greater than 50{\%} improvement in symptoms after implantation. Incontinence episodes, leakage severity, voiding frequency and pad use were significantly lower after implantation. Benefits were reported to persist 3 to 5 years after implantation. Adverse events were documented in 27 studies. Overall the reoperation rate in implanted cases was 33{\%}. The most common reason for surgical revision was relocation of the generator because of pain and infection. Common complications were pain at the implant or lead site in 25{\%} of patients, lead related problems such as lead migration in 16{\%}, replacement and repositioning of the implanted pulse generator in 15{\%}, wound problems in 7{\%}, adverse effects on bowel function in 6{\%}, infection in 5{\%} and generator problems in 5{\%}. Permanent removal of the electrodes was reported in 9{\%} of patients. Technical changes with time have been associated with decreased complication rates.Conclusions: There is evidence indicating that SNS is effective for decreasing symptoms in patients with urge incontinence. Adverse events occurred in about half of the implanted cases and surgical revision was performed in 33{\%}. No major irreversible complications were reported in the studies reviewed. Further research is required on the long-term effects of and quality of life in patients with SNS.",
keywords = "bladder, urinary incontinence, prostheses and implants, electric stimulation, equipment safety, IMPLANTATION TECHNIQUE, ROOT NEUROMODULATION, OVERACTIVE BLADDER, MULTICENTER, DYSFUNCTION, RETENTION, DIARY",
author = "Brazzelli, {Miriam Giovanna} and Murray, {Alison Catherine} and Fraser, {Cynthia Mary}",
year = "2006",
doi = "10.1016/S0022-5347(05)00326-5",
language = "English",
volume = "175",
pages = "835--41",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "3/1",

}

TY - JOUR

T1 - Efficicacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review

AU - Brazzelli, Miriam Giovanna

AU - Murray, Alison Catherine

AU - Fraser, Cynthia Mary

PY - 2006

Y1 - 2006

N2 - Purpose: We systematically reviewed the evidence on the efficacy and safety of sacral nerve stimulation (SNS) for severe urge incontinence.Materials and Methods: A systematic review was performed of primary studies of SNS for urge incontinence published in English between 1966 and May 2003, and identified in major electronic databases. Two reviewers independently selected studies, assessed their methodological quality and extracted data.Results: Four randomized controlled trials and 30 case series were identified. Evidence from the randomized controlled trials, involving approximately 120 patients, showed that; about 80% achieved continence or greater than 50% improvement in their main incontinence symptoms after SNS compared with about 3% of controls receiving conservative treatments while waiting for an implant. While case series were larger, they were methodologically less reliable. However, they showed similar results with 67% of patients becoming dry or achieving a greater than 50% improvement in symptoms after implantation. Incontinence episodes, leakage severity, voiding frequency and pad use were significantly lower after implantation. Benefits were reported to persist 3 to 5 years after implantation. Adverse events were documented in 27 studies. Overall the reoperation rate in implanted cases was 33%. The most common reason for surgical revision was relocation of the generator because of pain and infection. Common complications were pain at the implant or lead site in 25% of patients, lead related problems such as lead migration in 16%, replacement and repositioning of the implanted pulse generator in 15%, wound problems in 7%, adverse effects on bowel function in 6%, infection in 5% and generator problems in 5%. Permanent removal of the electrodes was reported in 9% of patients. Technical changes with time have been associated with decreased complication rates.Conclusions: There is evidence indicating that SNS is effective for decreasing symptoms in patients with urge incontinence. Adverse events occurred in about half of the implanted cases and surgical revision was performed in 33%. No major irreversible complications were reported in the studies reviewed. Further research is required on the long-term effects of and quality of life in patients with SNS.

AB - Purpose: We systematically reviewed the evidence on the efficacy and safety of sacral nerve stimulation (SNS) for severe urge incontinence.Materials and Methods: A systematic review was performed of primary studies of SNS for urge incontinence published in English between 1966 and May 2003, and identified in major electronic databases. Two reviewers independently selected studies, assessed their methodological quality and extracted data.Results: Four randomized controlled trials and 30 case series were identified. Evidence from the randomized controlled trials, involving approximately 120 patients, showed that; about 80% achieved continence or greater than 50% improvement in their main incontinence symptoms after SNS compared with about 3% of controls receiving conservative treatments while waiting for an implant. While case series were larger, they were methodologically less reliable. However, they showed similar results with 67% of patients becoming dry or achieving a greater than 50% improvement in symptoms after implantation. Incontinence episodes, leakage severity, voiding frequency and pad use were significantly lower after implantation. Benefits were reported to persist 3 to 5 years after implantation. Adverse events were documented in 27 studies. Overall the reoperation rate in implanted cases was 33%. The most common reason for surgical revision was relocation of the generator because of pain and infection. Common complications were pain at the implant or lead site in 25% of patients, lead related problems such as lead migration in 16%, replacement and repositioning of the implanted pulse generator in 15%, wound problems in 7%, adverse effects on bowel function in 6%, infection in 5% and generator problems in 5%. Permanent removal of the electrodes was reported in 9% of patients. Technical changes with time have been associated with decreased complication rates.Conclusions: There is evidence indicating that SNS is effective for decreasing symptoms in patients with urge incontinence. Adverse events occurred in about half of the implanted cases and surgical revision was performed in 33%. No major irreversible complications were reported in the studies reviewed. Further research is required on the long-term effects of and quality of life in patients with SNS.

KW - bladder

KW - urinary incontinence

KW - prostheses and implants

KW - electric stimulation

KW - equipment safety

KW - IMPLANTATION TECHNIQUE

KW - ROOT NEUROMODULATION

KW - OVERACTIVE BLADDER

KW - MULTICENTER

KW - DYSFUNCTION

KW - RETENTION

KW - DIARY

U2 - 10.1016/S0022-5347(05)00326-5

DO - 10.1016/S0022-5347(05)00326-5

M3 - Article

VL - 175

SP - 835

EP - 841

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 3/1

ER -