Sacral neuromodulation for neurogenic lower urinary tract dysfunction: systematic review and meta-analysis

Kessler, Thomas M; La Framboise, David; Trelle, Sven; Fowler, Clare J; Kiss, Gustav; Pannek, Jürgen; Schurch, Brigitte; Sievert, Karl-Dietrich; Engeler, Daniel S (2010). Sacral neuromodulation for neurogenic lower urinary tract dysfunction: systematic review and meta-analysis. European urology, 58(6), pp. 865-874. Amsterdam: Elsevier 10.1016/j.eururo.2010.09.024

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Context Treatment of neurogenic lower urinary tract dysfunction (LUTD) is a challenge, because conventional therapies often fail. Sacral neuromodulation (SNM) has become a well-established therapy for refractory non-neurogenic LUTD, but its value in patients with a neurologic cause is unclear. Objective To assess the efficacy and safety of SNM for neurogenic LUTD. Evidence acquisition Studies were identified by electronic search of PubMed, EMBASE, and ScienceDirect (on 15 April 2010) and hand search of reference lists and review articles. SNM articles were included if they reported on efficacy and/or safety of tested and/or permanently implanted patients suffering from neurogenic LUTD. Two reviewers independently selected studies and extracted data. Study estimates were pooled using Bayesian random-effects meta-analysis. Evidence synthesis Of the 26 independent studies (357 patients) included, the evidence level ranged from 2b to 4 according to the Oxford Centre for Evidence-Based Medicine. Half (n = 13) of the included studies reported data on both test phase and permanent SNM; the remaining studies were confined to test phase (n = 4) or permanent SNM (n = 9). The pooled success rate was 68% for the test phase (95% credibility interval [CrI], 50–87) and 92% (95% CrI, 81–98%) for permanent SNM, with a mean follow-up of 26 mo. The pooled adverse event rate was 0% (95% CrI, 0–2%) for the test phase and 24% (95% CrI, 6–48%) for permanent SNM. Conclusions There is evidence indicating that SNM may be effective and safe for the treatment of patients with neurogenic LUTD. However, the number of investigated patients is low with high between-study heterogeneity, and there is a lack of randomised, controlled trials. Thus, well-designed, adequately powered studies are urgently needed before more widespread use of SNM for neurogenic LUTD can be recommended.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Kessler, Thomas M. and Trelle, Sven

ISSN:

0302-2838

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:12

Last Modified:

11 Sep 2017 19:44

Publisher DOI:

10.1016/j.eururo.2010.09.024

PubMed ID:

20934242

Web of Science ID:

000283646600011

BORIS DOI:

10.7892/boris.2228

URI:

https://boris.unibe.ch/id/eprint/2228 (FactScience: 204549)

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