Author:

Keywords:

1103 Clinical Sciences, Urology & Nephrology, 3202 Clinical sciences

Abstract:

Introduction A prospective study was conducted to evaluate the success of neuromodulation in women with bladder emptying disorders with or without complex repetitive discharges and decelerations on concentric needle EMG of the external urethral sphincter (Fowler syndrome). Material and Methods Twenty-one patients received a definitive implant (Medtronic InterStim® System) between 1996-1998; 12 patients with Fowler's syndrome (57%) and 9 patients without (43%). Their mean age was 43 years (23-59) and the mean follow-up was 24.1 months (6-31). Follow-up was done every 3 months. An "excellent" response was defined as normal uroflowmetry without residual. A partial response was defined as abnormal uroflowmetry with a residual < 150 ml. Failure was defined as persisting retention or residual >150 ml. Results Overall, there was an excellent result in 62%, a partial response in 19% and failure in 19%. In the Fowler group, an excellent result was achieved in 75%, 8.4% had a partial response and 16.6% ended in failure. In the non-Fowler group, we noticed an excellent result in 45%, partial in 33% and poor in 22%. Conclusion Sacral nerve stimulation can be a successful treatment for women with bladder emptying disorders. The presence of complex repetitive discharges and decelerations on the concentric needle EMG is a positive prognostic factor. These results suggest refraining the non-Fowler patients from this expensive therapy. After reviewing any of the following Clinical Case Studies, we welcome you to post questions and/or topics in the SNS MDForum.