Authors' objectives:

To assess the efficacy, effectiveness, and safety of sacral neuromodulation (SN) in the treatment of urinary incontinence.

Authors' recommendations: This report concludes that the initial results of studies on the efficacy of sacral neuromodulation (SN) are promising in the short term. After 6 months of follow-up, between 47% and 50% of the patients of the group treated with SN recover continence completely (dry patients) and between 70% and 85% present improvements equal to or above 90% in terms of frequency of the episodes of UI and reduction in diaper consumption. This study also includes measurements of quality of life obtained from instruments such as the SF-36, with significant increases of certain dimensions detected, such as those that measure emotional and physical aspects, although quality of life overall is unchanged. The average/low seriousness complications (displacement of the electrode and/or wire, pain in the implant area or in other sites, infections, explantation) stand at around 40%. The failure of treatment, defined as less than 50% improvement in symptoms, was approximately 32% after 18 months. In the clinical series, improvement of the symptoms, particularly with regard to UI, was between 50 and 100% after 6 months, with a threshold improvement of 50% as reference. On the other hand, this treatment is expensive (the approximate price of a stimulation system with implant is 1,350,000 pesetas, including elements for the study prior to the permanent implant) and presents a substantial percentage of complications which, while not serious, require extra medical care. Therefore, and while data point to the benefit of SN, the reduced number of patients involved in the studies, the unequal follow-up periods, as well as the lack of homogeneity in the measurement of the results, leave question marks over the long-term impact of SN, quality of life, prognostic factors and its cost-effectiveness.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research (CAHTA)