Affiliations: Department of Urology, Hannover Medical School,
Hannover, Germany
Note: [] Correspondence to: Volker Grünewald, M.D., Hannover Medical School,
Department of Urology, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany;
Tel.: +49-511-532-3650; Fax: +49-511-532-3481
Abstract: Temporary electrical stimulation using anal or vaginal electrodes
and an external pulse generator has been a treatment modality for urinary urge
incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced
chronic electrical stimulation of the sacral spinal nerves using a permanently
implanted sacral foramen electrode and a battery powered pulse generator for
treatment of different kinds of lower urinary tract dysfunction, refractory to
conservative treatment. At our department chronic unilateral electrical
stimulation of the S3 sacral spinal nerve has been used for treatment of
vesi-courethral dysfunction in 43 patients with a mean postoperative follow up
of 43,6 months. Lasting symptomatic improvement by more than 50 % could be
achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18
of the 21 patients with urinary retention (85,7 %). Implants offer a sustained
therapeutic effect to treatment responders, which is not achieved by temporary
neuromodulation. Chronic neuromodulation should be predominantly considered in
patients with urinary retention. Furthermore in patients with motor urge
incontinence, refusing temporary techniques or in those requiring too much
effort to achieve a sustained clinical effect. Despite high initial costs
chronic sacral neuromodulation is an economically reasonable treatment option
in the long run, when comparing it to the more invasive remaining therapeutic
alternatives.
