Abstract
Objectives:
To assess the concomitant clinical improvement in incomplete spinal cord injury patients (SCIPs) suffering from neurogenic bowel symptoms (NBSs), neurogenic lower urinary tract symptoms (NLUTSs) and neurogenic erectile dysfunction (NED) using sacral neuromodulation (SNM) for NBSs and NLUTSs.
Methods:
Seventy-five SCIPs were selected. Before and during the follow-ups post-SNM, NLUTSs and NBSs were detected mainly through specific diaries. Erectile function was assessed using the International Index of Erectile Function composed of 5 questions (IIEF5). Quality of life (QoL) was measured with the Short Form 36 Health Survey questionnaire (SF-36). During the first stage, in which a permanent electrode was inserted percutaneously into the third sacral foramina and stimulated using an external generator, patients with NBSs or NLUTSs were required to improve their symptoms by at least 50% compared with baseline before proceeding to the second stage in which the generator was placed in the patient's buttock. NED patients needed to increase their IIEF5 score by at least 25% compared with baseline (evaluated initially 3 months after the second stage) in order to continue follow-up.
Results:
Fourteen out of 37 subjects who manifested two functional pelvic dysfunctions at baseline maintained notable clinical improvement in two pelvic functions (median follow-up >3 years). Six had non-obstructive retention (NOR) and NED, six double incontinence, and two constipation with NOR. In the general and mental health domains of the SF-36, all patients improved their scores by at least 20% compared with baseline.
Conclusions:
SNM may be beneficial to selected incomplete SCIP with concomitant pelvic functional disturbances.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Benevento BT, Sipski ML . Neurogenic bladder, neurogenic bowel and sexual dysfunction in people with spinal cord injury. Phys Ther 2002; 82: 601–612.
Fu G, Liao LM, Lü Z, Li JJ, Wu J, Ju YH et al. Neuromodulation for treatment for neurogenic bowel dysfunction. Zhonghua Wai Ke Za Zhi 2009; 47: 128–131.
Lombardi G, Del Popolo G . Clinical outcome of sacral neuromodulation in incomplete spinal cord injured patients suffering from neurogenic lower urinary tract symptoms. Spinal Cord 2009; 47: 486–491.
Lombardi G, Mondaini N, Giubilei G, Macchiarella A, Lecconi F, Del Popolo G . Sacral neuromodulation for lower urinary tract dysfunction and impact on erectile function. J Sex Med 2008; 5: 2135–2140.
American Spinal Injury Association. International Standards for Neurological and Functional Classification of Spinal Cord Injury Revised 1996. American Spinal Injury Association: Chicago, 1996.
Krogh K, Olsen N, Christensen P, Madsen JL, Laurbeg S . Colorectal transport during defecation in patients with lesions of the sacral spinal cord. Neurogastroenterol Motil 2003; 15: 25–31.
Rosen RC, Riley A, Wagner G, Osterloch IH, Kirkpatrick J, Mishra A . The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.
Forchheimer M, McAweeney M, Tate DG . Use of the SF-36 among persons with spinal cord injury. Am J Phys Med Rehabil 2004; 83: 390–395.
Abrams P . Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int 1999; 84: 14–15.
Wyndaele JJ, Madersbacher H, Kovindha A . Conservative treatment of the neuropathic bladder in spinal cord injured patients. Spinal Cord 2001; 39: 294–300.
Madersbacher H, Wyndaele JJ, Igawa Y, Abrams P, Khoury S, Wein A . Incontinence, 2nd edn. Health Publication Ltd, UK, 1999, pp 703–708.
Schurch B, Schmid DM, Karsenty G, Reitz A . Can neurologic examination predict type of detrusor sphincter-dyssynergia in patients with spinal cord injury? Urology 2005; 65: 243–246.
Leng WW, Chancellor MB . How sacral nerve stimulation neuromodulation works. Urol Clin North Am 2005; 2: 11–18.
Altomare DF, Rinaldi M, Petrolino M, Monitillo V, Sallustio P, Veglia A et al. Permanent sacral nerve modulation for fecal incontinence and associated urinary disturbances. Int J Colorectal Dis 2004; 19: 203–209.
Jarrett ME, Mowatt G, Glazener CM, Fraser C, Nicholls RJ, Grant AM et al. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 2004; 91: 1559–1569.
Gourcerol G, Gallas S, Michot F, Denis P, Leroi AM . Sacral nerve stimulation in fecal incontinence: are there factors associated with success? Dis Colon Rectum 2007; 50: 3–12.
Indar A, Young-Fadok T, Cornella J . A dual benefit of sacral neuromodulation. Surg Innov 2008; 15: 219–222.
Kenefick NJ, Vaizey CJ, Cohen CR, Nicholls RJ, Kamm MA . Double-blind placebo-controlled crossover study of sacral nerve stimulation for idiopathic constipation. Br J Surg 2002; 89: 1570–1571.
Michelsen HB, Buntzen S, Krogh K, Laurberg S . Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation. Dis Colon Rectum 2006; 49: 1039–1044.
Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C et al. Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 2010; 29: 213–240.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Lombardi, G., Nelli, F., Mencarini, M. et al. Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury. Spinal Cord 49, 629–636 (2011). https://doi.org/10.1038/sc.2010.176
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2010.176
Keywords
This article is cited by
-
Neuromodulation Following Spinal Cord Injury for Restoration of Bladder and Erectile Function
Current Bladder Dysfunction Reports (2023)
-
Sacral neuromodulation in congenital lumbo-sacral and traumatic spinal cord defects with neurogenic lower urinary tract symptoms: a single-center experience in children and adolescents
World Journal of Urology (2019)
-
An Update on the Management of Neurogenic Bladder
Current Bladder Dysfunction Reports (2017)
-
Worldwide Utilization Patterns of Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction
Current Bladder Dysfunction Reports (2016)
-
Neurogenic Bowel Dysfunction in Patients with Neurogenic Bladder
Current Bladder Dysfunction Reports (2016)
