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Purpose: Results of sacral neurostimulation in urinary retention are reported in the literature without distinction between the 2 functional disorders causing this condition, detrusor acontractility and functional outlet obstruction. We have suggested a stimulation test to differentiate irreversible bladder myopathy (or complete neurogenic lesion) from potential bladder contractility eligible for sacral neurostimulation., Materials and Methods: Direct electrostimulation of the sacral nerves was performed with the patient under general anesthesia. Urodynamic monitoring of bladder (detrusor contractility test) and bowel pressures were used. If no bladder contraction (negative detrusor contractility test) was recorded with positive somatic and bowel responses a irreversible bladder myopathy was supposed and the patient discharged home. If no bladder and no bowel contraction were recorded a complete neurogenic lesion was supposed and the patient was also discharged., Results: Of 96 patients tested with the detrusor contractility test 72 (65%) had no bladder contraction and were excluded from sacral neurostimulation therapy. In this series 15 patients had already been tested with percutaneous nerve evaluation on each S3 nerve with negative results. In 18 cases no bladder and no bowel contraction was evoked (neurogenic lesion). In the remaining 54 cases (bowel but no bladder contraction) a bladder myopathy was supposed. In 24 patients the detrusor contractility test was positive and 12 of these underwent implantation with a permanent device for sacral neurostimulation., Conclusions: The detrusor contractility test can be considered a reliable tool to rule out detrusor acontractility due to irreversible bladder myopathy or complete neurogenic lesion from sacral neurostimulation.

Purpose: We investigated the impact of sacral neuromodulation on quality of life and assessed the importance of quality of life for determining the success of sacral neuromodulation in patients with detrusor hyperactivity, including instability and hyperreflexia. We also compared it with parameters documented in a voiding diary., Materials and Methods: From May 1998 to December 2000, 82 female and 31 male patients 17 to 79 years old (mean age 51.1) with urge incontinence (63), urgency/frequency (5), voiding disturbance (41) and pelvic pain (4) resistant to conservative treatment were enrolled in a national prospective registry after showing a positive response to percutaneous nerve evaluation testing. Of the patients 47 who were 32 to 79 years old (mean age 59.2) with urge incontinence due to detrusor instability and 16 who were 27 to 51 years old (mean age 51.5) with hyperreflexia were asked to complete a validated self-reporting incontinence domain specific quality of life questionnaire before, and 3, 6, 9, 12, 18, 24 and 36 months after implantation., Results: Compared with baseline the quality of life index significantly improved at each followup, which strongly correlated with the decrease in the number of incontinence episodes., Conclusions: Evaluating quality of life may be an additional useful tool for assessing the results of sacral neuromodulation for urge incontinence. Our study confirms that sacral neuromodulation is effective therapy for urge incontinence that can have a positive effect on patient quality of life.

Purpose: The Italian Register was created in February 1997 to collect the national results of sacral neuromodulation. All Italian centers at which sacral neuromodulation is performed were invited to participate in our study. We present the results from retrospective and prospective registers., Materials and Methods: A total of 196 patients underwent permanent implantation of sacral neuromodulation and were enrolled in the Italian register. There were 18 males and 75 females in the retrospective, and 28 males and 75 females in the prospective studies. Student's t test was used to compare paired values, and the Wilcoxon rank sum and nonparametric tests were used when necessary., Results: Mean incontinent episodes daily plus or minus standard deviation for patients with detrusor instability went from 5.4 +/- 3.9 to 1.1 +/- 1.6 (median 5 and 0, respectively) at 12-month followup (p <0.001). For idiopathic retention average residual volume decreased from 277 to 108 cc (median 287 and 80, respectively), and 50% of patients stopped catheterization and another 13% catheterized once daily at 1-year after implantation. With neurogenic voiding disturbances, the results fluctuated with time from a minimum of 33% to a maximum 66% of patients who did not catheterize at 6-month followup and 12 months after implantation, respectively. At 12-month followup, 50% of patients with hyperreflexia had less than 1 incontinent episode daily. The problem was completely solved in 66% of patients in the retention group. Of patients in the urge incontinent population 39% were completely dry and 23% had less than 1 incontinent episode daily., Conclusions: Sacral neuromodulation is effective therapy for treating lower urinary tract symptoms resistant to less invasive therapy.