Sacral neuromodulation in urological indications: The Finnish experience

Objective. Sacral neuromodulation is a treatment modality for voiding dysfunction that is resistant to conventional medical and surgical treatments. In Finland, sacral neuromodulation has been used for the treatment of urgency-frequency syndrome, non-obstructive urinary retention and painful bladder/interstitial cystitis since 1996. Material and methods. The investigation retrospectively evaluated 180 tested patients, 74 of whom underwent permanent implantation of the InterStim device. Results. A positive test result leading to implantation was significantly more frequent among females than males. Among urinary retention patients, the patients with a positive test leading to implantation were significantly younger than those without implantation. The implantation operation time was significantly shorter when using a tined lead device compared with open electrode insertion (76 vs 122 min). The mean follow-up time was 41 months (range 0-143). Significant improvement after implantation was noted in the mean urinated volumes and number of daily urinations, as well as in the number of catheterizations in urgency-frequency syndrome and urinary retention, respectively. The subjective long-term outcome was similar in these indications. Surgical revision was required for 15 patients (20.3% of implanted patients). Conclusions. The difference in gender distribution compared with earlier published series may be explained by a selection bias due to the limited referrals of female patients from gynaecologists. The results favour the use of a tined lead device because of the shorter operating room time. Furthermore, the outcome seems to be more favourable among patients with a staged implant procedure compared with a one-stage operation with a tined lead device.