Efficacy and Safety of Sacral Neuromodulation in the Treatment of Females with Refractory Idiopathic Non-Obstructive Urinary Retention
Urology Journal,
Vol. 22 (2025),
5 Dey 2025
,
Page 8569
https://doi.org/10.22037/uj.v22i.8569
Abstract
Purpose: Non-obstructive urinary retention (NOUR) is the inability to empty the bladder with no physical obstruction to urine flow. It can occur as a result of neurological disorders or be idiopathic. In younger women, it may be caused by Fowler’s syndrome (FS), a rare disorder in which the urethral sphincter fails to relax to allow urine to pass normally. This study covers both idiopathic NOUR and FS. Sacral neuromodulation (SNM) has been introduced as an effective option for patients with NOUR.
Materials and Methods: Forty-two patients (aged 17 to 61 years) suffering from refractory NOUR who had a successful first-stage SNM with the Interstim II device, and in whom the second stage was completed, were prospectively studied in the department of neurogenic bladder and neuromodulation in our hospital from February 2016 to August 2019 to evaluate the efficacy and safety of SNM.
Results: The study included forty-two women with NOUR: 20 (47%) with FS and 22 (53%) with idiopathic NOUR. Their mean age was 27.2 ± 12.4 years. Thirty-eight (90%) of them had a successful trial phase (responders) with more than 50% improvement in their voiding parameters. After continued follow-up, a clinical success rate of 79% (30 out of 38 cases) was achieved, with a median follow-up period of 28 ± 8 months. The voiding parameters of these 38 patients showed statistically significant improvement after SNM. Their post-void residual volume dropped significantly from 330 ± 77 mL to 97 ± 55 mL (P < 0.001), average voided volume increased from 60 ± 23 mL to 265 ± 99 mL (P < 0.001), and the number of clean intermittent catheterizations per day fell from 5.6 ± 1 to 1.3 ± 1.6 (P < 0.001). The total number of patients who required surgical revision was 10 (26.4%), for reasons including malfunction due to external trauma in four patients (10.5%), continuous pain in four (10.5%), and device infection in two (5%).
Conclusion: SNM is an effective and safe option for women with refractory idiopathic non-obstructive urinary retention and Fowler's syndrome.
- Fowler syndrome ; sacral neuromodulation ;
- idiopathic non-obstructive urinary retention
How to Cite
References
1. Bruce C. National institute for health care excellence interventional procedure consultation document, June 2015. Sacral nerve stimulation for idiopathic chronic non-obstructive urinary retention [internet]. Available from 1 (nice.org.uk). [Accessed 2 October 2019]
2. Stoffel JT, Peterson AC, Sandhu JS, Suskin AM, Wei JT, Lightner DJ. AUA white paper on nonneurogenic chronic urinary retention: consensus definition, treatment algorithm, and outcome end points. J Urol. 2017;198:153-60.
3. Fowler CJ, Christmas TJ, Chapple CR, Parkhouse HF, Kirby RS, Jacobs HS. Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome? BMJ. 1988;297:1436-8.
4. Shaker HS, Hassouna M. Sacral root neuromodulation in idiopathic nonobstructive chronic urinary retention. J Urol. 1998;159:1476-8.
5. Mehmood S, Altaweel WM. Long-term outcome of sacral neuromodulation in patients with idiopathic nonobstructive urinary retention: Single-center experience. Urol Ann. 2017;9:244.
6. Szymański JK, Słabuszewska-Jóźwiak A, Jakiel G. Fowler's Syndrome-The Cause of Urinary Retention in Young Women, Often Forgotten, but Significant and Challenging to Treat. Int J Environ Res Public Health. 2021;18:3310.
7. Fowler CJ. Neurological disorders of micturition and their treatment. Brain. 1999;122:1213-31.
8. Wein AJ, Dmochowski RR. Neuromuscular Dysfunction of the Lower Urinary Tract. In: Campbell-Walsh Urology. 11th ed. 2019:304.
9. Swinn MJ, Wiseman OJ, Lowe E, Fowler CJ. The cause and natural history of isolated urinary retention in young women. J Urol. 2002;167:151-6.
10. Ismail MB, Abdulhussein WQ. Efficacy and Safety of Sacral Neuromodulation in Treatment of Refractory Overactive Bladder. Indian J Forensic Med Toxicol. 2020;15:1315-21.
11. Ismail MB, Abdulhussein WQ. The Safety and Efficacy of Sacral Neuromodulation on Refractory Urgency Urinary and Fecal Incontinence in Iraqi Patients. Medico Legal Update. 2021;21:575-9.
12. Dasgupta R, Wiseman OJ, Kitchen N, Fowler CJ. Long-term results of sacral neuromodulation for women with urinary retention. BJU Int. 2004;94:335-7.
13. De Ridder D, Ost D, Bruyninckx F. The presence of Fowler’s syndrome predicts successful long-term outcome of sacral nerve stimulation in women with urinary retention. Eur Urol. 2007;51:229-34.
14. Schmidt RA, Tanagho EA. Feasibility of controlled micturition through electric stimulation. Urol Int. 1979;34:199-230.
15. Banakhar M, Hassouna M. Percutaneous nerve evaluation test versus staged test trials for sacral neuromodulation: sensitivity, specificity, and predictive values of each technique. Int Neurourol J. 2016;20:250.
16. Janknegt RA, Weil EH, Eerdmans PH. Improving neuromodulation technique for refractory voiding dysfunctions: two-stage implant. Urology. 1997;49:358-62.
17. Scheepens WA, Van Koeveringe GA, de Bie RA, Weil EH, van Kerrebroeck PE. Long-term efficacy and safety results of the two-stage implantation technique in sacral neuromodulation. BJU Int. 2002;90:840-5.
18. Van Kerrebroeck PE, Marcelissen TA. Sacral neuromodulation for lower urinary tract dysfunction. World J Urol. 2012;30:445-50.
19. Thompson JH, Sutherland SE, Siegel SW. Sacral neuromodulation: therapy evolution. Indian J Urol. 2010;26:379.
20. Clothier JC, Wright AJ. Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment. Pediatr Nephrol. 2018;33:381-94.
21. Trump T, Goldman HB. Sacral neuromodulation for urinary incontinence. Continence. 2024;12:101697.
22. Coolen RL, Groen J, Stillebroer AB, Scheepe JR, Witte LP, Blok BF. Two-Staged Sacral Neuromodulation for the Treatment of Nonobstructive Urinary Retention: A Multicenter Study Assessing Predictors of Success. Neuromodulation. 2023;26:1823-30.
23. Van Kerrebroeck PE, Marcelissen TA. Sacral neuromodulation for lower urinary tract dysfunction. World J Urol. 2012;30:445-50.
24. Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol. 1988;140:1331-9.
25. Al-Zahrani AA, Elzayat EA, Gajewski JB. Long-term outcome and surgical interventions after sacral neuromodulation implant for lower urinary tract symptoms: 14-year experience at 1 center. J Urol. 2011;185:981-6.
26. Gross C, Habli M, Lindsell C, South M. Sacral neuromodulation for nonobstructive urinary retention: a meta-analysis. Female Pelvic Med Reconstr Surg. 2010;16:249-53.
27. Peeters K, Sahai A, De Ridder D, Van Der Aa F. Long-term follow-up of sacral neuromodulation for lower urinary tract dysfunction. BJU Int. 2014;113:789-94.
28. van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, Lycklama á Nijholt AA, Siegel S, Jonas U, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007;178:2029-34.
29. Sukhu T, Kennelly MJ, Kurpad R. Sacral neuromodulation in overactive bladder: a review and current perspectives. Res Rep Urol. 2016;8:193-9.
30. Siegel SW, Catanzaro F, Dijkema HE, Elhilali MM, Fowler CJ, Gajewski JB, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology. 2000;56:87-91.
- Abstract Viewed: 299 times
- Just Accepted/8569 Downloaded: 127 times