Sacral Neuromodulation in an Older Urge Incontinent Population

Drs. Cindy Amundsen, Brian J. Flynn, George D. Webster

Duke University Medical Center

Durham, North Carolina

Purpose: The success of sacral neuromodulation in the treatment of urge incontinence has been reported primarily in young populations.  Herein we report the response rate to the percutaneous test stimulation and the success rate of sacral neuromodulation after permanent implantation in an older urge incontinent population.
Materials and methods : A cohort of 20 patients older than 55 (average 69, range 55-79) years, completed an extensive urogynecologic history including a 3 day bladder diary and disease specific quality of life questionnaire, focused physical examination and urodynamics. All patients had failed conventional therapy for the treatment of urge incontinence. Percutaneous S3 sacral nerve test stimulation electrodes were placed under fluoroscopic guidance and patients then completed a 7 day bladder diary. Patients were considered candidates for permanent implantation if they were cured or had a greater than 50% improvement in incontinent episodes.  Responders were implanted and completed a questionnaire, bladder diary, and disease specific quality of life questionnaire. 
Results:   10 of the 20 patients (50%) responded to the test stimulation.  There was no difference between responders and nonresponders with regards to age, duration of problem, number of incontinent episodes, pad usage, voided volumes and frequency of voids.  Detrusor instability was documented on urodynamics in 60% of the nonresponders and responders. Both groups recorded high Incontinence Impact Questionnaire (IIQ).
The average follow up after permanent implantation is 5 months (range 1-13 months).  No patient experienced perioperative morbidity.  Two patients developed discomfort over the neurostimulator. There was a statistical significant Improvement in number of incontinent episodes/day[t= 4.0, p< .05], pads/day [t=4.4, p< .05], and frequency of voids [t=4.3, p< .05].  Improvement in patients’ IIQ score was also statistically significant [t=3.6 , p< .05].  Seven of the ten patients (70%) are pleased they had the procedure performed the others are uncertain.
Conclusion:   Our small cohort suggests that while an older urge incontinent patient population has similar improvement with sacral neuromodulation to younger age patients, cure rates may be lower.
Keywords: sacral neuromodulation, urge incontinence