Sacroneuromodulation may be effective for neurogenic lower urinary tract dysfunction

This article is from the NEJM Journal Watch

Can Neurogenic Lower Urinary Tract Dysfunction Be Treated Effectively?

The presence or absence of effective therapy for neurogenic lower urinary tract dysfunction

Review by Jaime Toro, MD

Sacral neuromodulation may be an effective treatment
for neurogenic lower urinary tract dysfunction (NLUTD).

NLUTD is a common condition
in neurology that causes damage to the function of the patient's body.
To date, there is no satisfactory standard of care
.
For non-neurogenic lower urinary tract dysfunction (non-NLUTD), sacral neuromodulation (SNM) is a mature therapy
.
However, there are no sufficient randomized controlled trials to demonstrate its benefit
for NLUTD.
From June 2012 to June 2017, the researchers conducted this false-controlled, double-blind, multicenter trial, which enrolled 124 patients with symptomatic refractory NLUTD: 47 had urinary urgency, 38 had urinary retention, and 39 had
both symptoms.
After inserting the wire into the S3 sacral foramen, all patients underwent SNM testing
.
If successful, the neurostimulator is permanently placed
.

Of the 124 patients who underwent the SNM test, 65 (52%) had at least a 50% improvement in lower urinary tract function, of which 64 were placed with a neurostimulator, and after the optimization period ended, 60 were randomly divided into two groups, one group turned on the neurostimulator (SNM on) and the other group turned off the neurostimulator (SNM off).

After 2 months of intervention, the success rate of the SNM open group was 76%.

In the SNM shutdown group, 42% of patients showed sustained results
despite the neurostimulator being turned off.

comments

In strictly selected patients, SNM effectively corrects refractory hyponeurogenic urinary tract dysfunction
.
We need larger studies to determine whether neurostimulation therapy can be routinely applied to specific patients with
NLUTD.

Commented on the article

Liechti MD et al.
Sacral neuromodulation for neurogenic lower urinary tract dysfunction.
NEJM Evid 2022 Jul 7; [e-pub].
(https://doi.
org/10.
1056/EVIDoa2200071)