ABSTRACT

Introduction:

Our target was to retrospectively examine the results of Sacral Nerve Modulation (SNM) in patients complaining of simultaneous bladder and the rectum dysfunctions, here called double pelvic dysfunction (DPD).

Methods:

In 2009, in six Italian centres, patients treated with SNM were asked to complete a self-assessment questionnaire for DPD. The questionnaire investigated the changes in micturition and rectal symptoms after SNM using specific questions for each dysfunction and symptom - overactive bladder (OAB), urinary retention (UR), faecal incontinence (FI) and constipation (Co).

Results:

Data obtained from forty-four patients with a mean follow-up period of 56.9 months were retrospectively analysed. 73% of patients treated with SNM for DPD reported a significant clinical improvement, and in particular we observed an improvement of 68% for UR+Co, 78% for OAB+Co and 75% for OAB+FI. Among the OAB+Co and UR+Co cases a higher percentage showed a clinical improvement in the vesical alterations (100% and 95% respectively) than in the anorectal ones (79% and 68%). In the OAB+FI group, on the other hand, a higher percentage of cases showed improvements in the anorectal alterations (100%) than in the vescical ones (75%). The improvement was confirmed by a reduction in use of devices and incontinence protection products (pads, self-catheterization and laxatives/enemas). Neurogenic patients had a better outcome than the non-neurogenic ones especially in the OAB+FI group (p=0.021).

Conclusions:

In our survey SNM has been more effective in DPD with FI and OAB, especially in a picture of neurological DPD. Therefore, considering also the economic aspect, SNM seems a viable option in highly selected cases of neurogenic DPD including FI. Retrospectively analysed through a patient self-assessment questionnaire, SNM is effective in simultaneous bladder and rectum dysfunction especially with neurogenic faecal incontinence.