The understanding of the utility of sacral neuromodulation (SNM) for neurogenic lower urinary tract dysfunction (NLUTD) is limited, with only small series in the literature. The aim of this study was to evaluate the clinical outcomes of SNM for treatment of NLUTD.

A retrospective analysis of patients who received a permanent SNM implant between December 2014 and March 2021 was conducted. Patients completed a urodynamic test pre-operatively. They completed a 3-day bladder diary, uroflowmetry and post-void residual (PVR) measurement pre-operatively and at 6-monthly intervals post-operatively following SNM insertion. Urinary function, patient reported outcome measures and adverse events were assessed.

Of 41 patients who underwent a test phase, 36 patients (26 female, 10 male) (88%) received a permanent SNM implant. The mean follow-up duration was 25±20 months, with the majority (89%, n=32) of patients reporting a >50% improvement on bladder diary evaluation. There was a significant increase in void volume (p<0.001), decrease in PVR (p<0.001), decrease in voiding frequency (p<0.001), decrease in incontinence episodes (p=0.002) and decrease in pad number (p<0.001). There was no significant difference in peak flow (p=0.21). The progressive nature of the underlying neurological condition had no significant effect on post-operative void volume (p=0.13), PVR (p=0.98), voiding frequency (p=0.61), incontinence episodes (p=0.49), pad number (p=0.29) or peak flow (p=0.92). 

All patients underwent reprogramming of the sacral neuromodulation device multiple times to optimise clinical benefit, minimise adverse effects and reduce amplitude to prolong battery life. At 6-month follow-up, 47% (n=17) required reprogramming due to poor efficacy or adverse effects, 28% (n=10) remained on the initial program but required an increase in settings due to reduction in efficacy, 19% (n=7) remained on the initial program and settings due to good efficacy and 6% (n=2) remained on the initial program with good efficacy but had a reduction in settings to reach a low amplitude.

SNM is part of the ICS treatment algorithm for patients with NLUTD and has been described in the European Association of Urology (EAU) guidelines as a treatment for NLUTD. However, the role of SNM for NLUTD is not well-documented. There is a lack of randomised controlled trials for SNM in NLUTD. In light of this, robust case series are helpful in increasing available evidence. Our results confirm that SNM is a safe and effective therapy for NLUTD. Our study shows SNM efficacy for both patients with detrusor overactivity and non-obstructive urinary retention. These findings provide clinically meaningful results and potential to improve quality of life in a cohort of patients with life-limiting neurological conditions.

SNM is a safe and effective therapy for NLUTD in the context of both progressive and non-progressive neurological conditions. It should be offered more readily to patients with NLUTD given it is a minimally invasive treatment option with potential to make clinically meaningful improvement to quality of life.