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Percutaneous tibial nerve stimulation (PTNS) in the treatment of non obstructive urinary retention: Long term results
677 LONG TERM
678
FOLLOW UP OF RESINIFERATOXIN INTRAVESICAL ADMINISTRATION IN THE TREATMENT OF DETRUSOR HYPERREFLEXIA IN SPINAL CORD INJURED PATIENTS
BOTULINUM-A TOXIN DETRUSOR INJECTIONS IN THE TREATMENT OF NON-NEUROLOGIC AND NEUROLOGIC CASES OF URGE INCONTINENCE
A.‘, Di Stasi S.‘, Stephen R.‘, Navarra P.‘, Scivoletto G.‘, Mearini E.‘, Porena M.‘, Pizzimsso G.’
Loch A.‘, Loch T.‘, Osterhage
Giannantoni
‘University of Perugia, Department of Urology, Perugia, Italy, ‘Tar Vergata University of Rome, Department of Urology, Rome, Italy, ‘Physion, Laboratories, Mirandola (MO), Italy, ‘Catholic University of Rome, Department of Pharmachology, Rome, Italy, ‘SLucia Rehabilitation Hospital, Spinal Cord Unit, Rome, Italy INTRODUCTION & OBJECTIVES: To evaluate the long term results of resiniferatoxin (RTX) intravesical administration for the treatment of refractory detrusor hyperreflexia and urinary incontinence in spinal cord injured (SCI) patients. MATERIAL & METHODS: Eleven patients were included in this prospective study. After a basal evaluation with urodynamics and the frequency of daily incontinent episodes, patients received intravesical administrations of RTX 0.6 mM in 50 ml of normal saline. RTX instillations were repeated when there was recurrence of urinary symptoms and/or urodynamic worsening. Uninhibited detrusor contractions (UDC) threshold and maximum pressure, and maximum bladder capacity were measured at baseline and during follow up. The frequency of daily incontinent episodes was recorded by means of a voiding diary. Local or systemic side effects were also noted. RESULTS: The mean follow up was 13.7+6.5 months, the number of instillations/patient was 7.113.4 so that the time between consecutive instillations averaged 53.3110.8 days. There was a significant increase of uninhibited detrusor contractions (UDC) threshold and of bladder capacity at 6, I2 and 18 months follow up, as compared to baseline. Mean UDC threshold increased from 90.6555.5 ml at baseline, to 233.3165.5 at 6 mos, to 270.2+75.4 at 12 mos and to 283.2599.9 to 18 mos follow up (between baseline and 6 mos follow up: p
J.‘, Alloussi S.‘, StGckle M.’
‘Universitaetsklinik des Saarlandes, Urology, Homburg, ‘Universitaetsklinik des Saarlandes, Neurology, Homburg, ‘Staedtisches Krankenhaus, Urology, Neunkirchen, &many
Germany, Germany,
INTRODUCTION & OBJECTIVES: In a prospective study we tested the efticacy, effect duration and possible complications of Botulinum-A Toxin (BTX-A) in cases of treating resistant urge incontinence in non-neurologic and neurologic patients. MATERIAL & METHODS: Between April 200 I and September 2002 thirty patients (age 1 l-74) were injected with BTX-A into the detrusor muscle. Pretreatment evaluation included an urodynamic investigation. Urodynamics were repeated 4 weeks after the injection and than all 3 months. Before treatment, in all patients a high grade of motoric urge incontinence was measured. Two patients showed a vesicorenal reflux IV’-V. Three patients suffered under an interstitial cystitis (IC). Under local anaesthesia a total of 200 units of botulinum-A toxin were injected into the detrusor muscle at 20 sites cystoscopic control. sparing the trigone. RESULTS: A significant improvement in symptoms was seen in 20 of the 30 patients after 6 days to 4 weeks. In these patients the urinary frequency returned almost to normal. The number of pads was reduced between 50.100%. The functional bladder capacity was elevated from 150-250ml to 400-450ml. The detrusor pressure was reduced from over 100 to 20-70 cmH,O. Simultaneously. the median flow rate was reduced to 4-12 mlisec; mtcturation time was prolonged to 40-120 sec. The mean post-void residual urine volume increased significantly (O-50 vs. 50-200 ml). Complications were one case of acute retention and one significant hematuria. Follow-up of these patients indicate that the effects can last 8 months (median). Therapy resistant were all the patients with IC.
CONCLUSIONS: In SC1 patients with refractory detrusor hyperreflexia and urinary incontinence, repeated intravesical administrations of RTX are a safe and effective treatment for times exceeding one year.
CONCLUSIONS: Detrusor muscle BTX-A injections seem to be a safe and feasible therapeutic option not only for neurologic caused urge incontinence but also for idiopathic incontinence. Complications in both groups were minimal. Primary candidates for BTX-A treatment should be patients with contraindications or non-response to oral anticholinergic drugs.
679
680
LOW ACUTE LEAD MIGRATION RATE USING MINIMALLY INVASIVE METHOD TO TREAT URINARY VOIDING DISORDERS WITH SACRAL NEUROMODULATION Ruiz-Cerdd J.‘. Hassouna M.‘, J..
May
Tu L.‘,
Kiss G.‘, Van Kcrrebroeck
P.‘. Del
PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS) IN THE TREATMENT OF NON OBSTRUCTIVE URINARY RETENTION: LONG TERM RESULTS
Pop010
CT.“, Vanma
‘La Fe University Ilospital, Urology, Valencia, Spain, ‘Toronto Hospital Western Division, Urology, Toronto, Canada, ‘Sherbrooke Hospital, Urolo’gy, Sherbrooke, Canada, ‘LKH-Univsitatskliniken Innsbruck, Urology, Innsbruck, Austria, ‘Academisch Ziekenhuis Maastricht, Urology, Maastricht, The Netherlands, “Careggi Hospital, Urology, Firenze, Italy, ‘Royal Victoria Infirmary, Urology, Newcastle, United Kingdom INTRODUCTION & OBJECTIVES: This abstract captures the initial experience involving a new, percutaneous chronic lead implanted as part of a neurostimulator system used to treat voiding disorders. We evaluated the lead migration rate and physician satisfaction at implant and at six weeks after implant. MATERIAL & METHODS: The tined lead (Models 3093 and 3889) was evaluated as part of the InterStim neurostimulator system (Medtronic, Minneapolis, USA) by seven physicians in Europe and Canada following CE approval. The lead is characterized by a sutureless design with tines acting as anchors, requiring fewer procedural steps than previous techniques and can be implanted under local anaesthesia. The use of local anaesthesia allows for patlent sensory response to be captured during the implant procedure. Visual, tactile and fluoroscopic markers on the lead help ensure optimal lead placement and ay result in better patient outcomes. 1) RESULTS: 22 patients who met no exclusion criteria (77% female, age 30s -80s) were implanted with the tined lead. Patient’s body statore ranged from thin to heavy. The majority (52%) were implanted under local anaesthesia; one additional patient received conscious sedation. Most patients (91%) were implanted in the S3 and were split evenly between the left and right sides. At implant, all physicians expressed satisfaction with the handling of the lead and most (95%) were pleased with the ability to place and secure the anchor. After six weeks, no lead migrations were recorded greater than 1 mm (n=l). All physicians were satisfied with the performance of the lead. Two leads were explanted, three were still in evaluation and I7 were implanted with a Neurostimulator. No patients experienced device- or procedure-related adverse events.
lJm\ers~t) Tar Veelgata, Urolog). Rome. Italy. ‘Un~wrs~ty Tot Vcrgata, Neurology. Rome. Italy INTRODUCTION & OBJECTIVES: Several stud~evon the effects of percutaneouh tlhutl nerve Ftimulatmn (PTNS) on overactive bladdersyndrome have been puhhshed; on the other hand. only few data are available on the results of this treatment on non obstructwe urmary retention. Furthermore. nvailahls data are hmlted to periods of ohserwtlon of 12 weeks, w,hlle few data on the long-term result\ are available. Thus, the axm of our qtudy was to mvesngate the long-term results of PTNS on patIenta with non-obstructwe urinary retention
patwnts
MATERIAL & METHODS: 44 (35 females, Y males) were enrolled m a 12.week prospective study. All patients had pathologic post-void residual urine (> 100 ml) and were performing intermittent cathkteris&ions. All patients showed a urodynamic pattern of detrusor undera&ivity, with no sign of bladder outlet obstruction. Stimulation was performed weekly, according to the Staller technique. At 0 and 12 weeks voiding diary and quality of life questionnaire (SF-36) were completed Patients showing a reduction >50% of the total residual unne (catheterised urine per 24 h, keepmg constant the number of catheterisation dunng the I2 weeks) were considered responders and were treated with less frequent stimulations. Pabents showing a reduction or a loss of the results after the mcreasr of time behveen stimulations were treated more frequently. Every I2 weeks pattents completed voiding diary and questionnaire on quality of life. Patients showing residual urine of less than 100 ml in one of the dally catheterisatmns were mstructed to abolish this catheterisation. Results at week 0 and 12 and of the last evaluation available for each responder patient have been considered and statistically compared RESULTS: 35144 patlents (79 5%) showed a chmcal unprovement ;-50% and continued the protocol of stimulation after the I2 weeks Mean follow-up of these patients is 13.6 (2-3 I ) months. Results at week 0 and 12 and of the last available evaluation (LAE) for each responder patient are reported IO table. l7i35 patients (48.6%), still maintaining the results obtained, dropped out the protocol for personal reasons. 15/35 patients (42.X%), havmg lost the results of the treatment. needed to he stimulated more frequently. 14135 patients (40%) stopped the regimen of mtermittent catheterisations
Legend: +week I2 vs. meek 0; *LAE vs. week 0
CONCLUSIONS: The tined lead available with the InterStim neurostimulator allows a simpler, percutaneous implant method that minimizes lead migrations in the weeks following placement. European
Urology Supplements 2 (2003) No. 1, pp. 172
CONCLUSIONS: PTNS seems to he an effictive. mmunally m\asive treatment of non-obstructive urinary retent!on. with results lastmg to a mean follow-up of lmore than I3 months. The neccsslty of frequent aud office based stimulation rrssrons 1sthe cause of a large patrents‘dropout.
678
FOLLOW UP OF RESINIFERATOXIN INTRAVESICAL ADMINISTRATION IN THE TREATMENT OF DETRUSOR HYPERREFLEXIA IN SPINAL CORD INJURED PATIENTS
BOTULINUM-A TOXIN DETRUSOR INJECTIONS IN THE TREATMENT OF NON-NEUROLOGIC AND NEUROLOGIC CASES OF URGE INCONTINENCE
A.‘, Di Stasi S.‘, Stephen R.‘, Navarra P.‘, Scivoletto G.‘, Mearini E.‘, Porena M.‘, Pizzimsso G.’
Loch A.‘, Loch T.‘, Osterhage
Giannantoni
‘University of Perugia, Department of Urology, Perugia, Italy, ‘Tar Vergata University of Rome, Department of Urology, Rome, Italy, ‘Physion, Laboratories, Mirandola (MO), Italy, ‘Catholic University of Rome, Department of Pharmachology, Rome, Italy, ‘SLucia Rehabilitation Hospital, Spinal Cord Unit, Rome, Italy INTRODUCTION & OBJECTIVES: To evaluate the long term results of resiniferatoxin (RTX) intravesical administration for the treatment of refractory detrusor hyperreflexia and urinary incontinence in spinal cord injured (SCI) patients. MATERIAL & METHODS: Eleven patients were included in this prospective study. After a basal evaluation with urodynamics and the frequency of daily incontinent episodes, patients received intravesical administrations of RTX 0.6 mM in 50 ml of normal saline. RTX instillations were repeated when there was recurrence of urinary symptoms and/or urodynamic worsening. Uninhibited detrusor contractions (UDC) threshold and maximum pressure, and maximum bladder capacity were measured at baseline and during follow up. The frequency of daily incontinent episodes was recorded by means of a voiding diary. Local or systemic side effects were also noted. RESULTS: The mean follow up was 13.7+6.5 months, the number of instillations/patient was 7.113.4 so that the time between consecutive instillations averaged 53.3110.8 days. There was a significant increase of uninhibited detrusor contractions (UDC) threshold and of bladder capacity at 6, I2 and 18 months follow up, as compared to baseline. Mean UDC threshold increased from 90.6555.5 ml at baseline, to 233.3165.5 at 6 mos, to 270.2+75.4 at 12 mos and to 283.2599.9 to 18 mos follow up (between baseline and 6 mos follow up: p
J.‘, Alloussi S.‘, StGckle M.’
‘Universitaetsklinik des Saarlandes, Urology, Homburg, ‘Universitaetsklinik des Saarlandes, Neurology, Homburg, ‘Staedtisches Krankenhaus, Urology, Neunkirchen, &many
Germany, Germany,
INTRODUCTION & OBJECTIVES: In a prospective study we tested the efticacy, effect duration and possible complications of Botulinum-A Toxin (BTX-A) in cases of treating resistant urge incontinence in non-neurologic and neurologic patients. MATERIAL & METHODS: Between April 200 I and September 2002 thirty patients (age 1 l-74) were injected with BTX-A into the detrusor muscle. Pretreatment evaluation included an urodynamic investigation. Urodynamics were repeated 4 weeks after the injection and than all 3 months. Before treatment, in all patients a high grade of motoric urge incontinence was measured. Two patients showed a vesicorenal reflux IV’-V. Three patients suffered under an interstitial cystitis (IC). Under local anaesthesia a total of 200 units of botulinum-A toxin were injected into the detrusor muscle at 20 sites cystoscopic control. sparing the trigone. RESULTS: A significant improvement in symptoms was seen in 20 of the 30 patients after 6 days to 4 weeks. In these patients the urinary frequency returned almost to normal. The number of pads was reduced between 50.100%. The functional bladder capacity was elevated from 150-250ml to 400-450ml. The detrusor pressure was reduced from over 100 to 20-70 cmH,O. Simultaneously. the median flow rate was reduced to 4-12 mlisec; mtcturation time was prolonged to 40-120 sec. The mean post-void residual urine volume increased significantly (O-50 vs. 50-200 ml). Complications were one case of acute retention and one significant hematuria. Follow-up of these patients indicate that the effects can last 8 months (median). Therapy resistant were all the patients with IC.
CONCLUSIONS: In SC1 patients with refractory detrusor hyperreflexia and urinary incontinence, repeated intravesical administrations of RTX are a safe and effective treatment for times exceeding one year.
CONCLUSIONS: Detrusor muscle BTX-A injections seem to be a safe and feasible therapeutic option not only for neurologic caused urge incontinence but also for idiopathic incontinence. Complications in both groups were minimal. Primary candidates for BTX-A treatment should be patients with contraindications or non-response to oral anticholinergic drugs.
679
680
LOW ACUTE LEAD MIGRATION RATE USING MINIMALLY INVASIVE METHOD TO TREAT URINARY VOIDING DISORDERS WITH SACRAL NEUROMODULATION Ruiz-Cerdd J.‘. Hassouna M.‘, J..
May
Tu L.‘,
Kiss G.‘, Van Kcrrebroeck
P.‘. Del
PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS) IN THE TREATMENT OF NON OBSTRUCTIVE URINARY RETENTION: LONG TERM RESULTS
Pop010
CT.“, Vanma
‘La Fe University Ilospital, Urology, Valencia, Spain, ‘Toronto Hospital Western Division, Urology, Toronto, Canada, ‘Sherbrooke Hospital, Urolo’gy, Sherbrooke, Canada, ‘LKH-Univsitatskliniken Innsbruck, Urology, Innsbruck, Austria, ‘Academisch Ziekenhuis Maastricht, Urology, Maastricht, The Netherlands, “Careggi Hospital, Urology, Firenze, Italy, ‘Royal Victoria Infirmary, Urology, Newcastle, United Kingdom INTRODUCTION & OBJECTIVES: This abstract captures the initial experience involving a new, percutaneous chronic lead implanted as part of a neurostimulator system used to treat voiding disorders. We evaluated the lead migration rate and physician satisfaction at implant and at six weeks after implant. MATERIAL & METHODS: The tined lead (Models 3093 and 3889) was evaluated as part of the InterStim neurostimulator system (Medtronic, Minneapolis, USA) by seven physicians in Europe and Canada following CE approval. The lead is characterized by a sutureless design with tines acting as anchors, requiring fewer procedural steps than previous techniques and can be implanted under local anaesthesia. The use of local anaesthesia allows for patlent sensory response to be captured during the implant procedure. Visual, tactile and fluoroscopic markers on the lead help ensure optimal lead placement and ay result in better patient outcomes. 1) RESULTS: 22 patients who met no exclusion criteria (77% female, age 30s -80s) were implanted with the tined lead. Patient’s body statore ranged from thin to heavy. The majority (52%) were implanted under local anaesthesia; one additional patient received conscious sedation. Most patients (91%) were implanted in the S3 and were split evenly between the left and right sides. At implant, all physicians expressed satisfaction with the handling of the lead and most (95%) were pleased with the ability to place and secure the anchor. After six weeks, no lead migrations were recorded greater than 1 mm (n=l). All physicians were satisfied with the performance of the lead. Two leads were explanted, three were still in evaluation and I7 were implanted with a Neurostimulator. No patients experienced device- or procedure-related adverse events.
lJm\ers~t) Tar Veelgata, Urolog). Rome. Italy. ‘Un~wrs~ty Tot Vcrgata, Neurology. Rome. Italy INTRODUCTION & OBJECTIVES: Several stud~evon the effects of percutaneouh tlhutl nerve Ftimulatmn (PTNS) on overactive bladdersyndrome have been puhhshed; on the other hand. only few data are available on the results of this treatment on non obstructwe urmary retention. Furthermore. nvailahls data are hmlted to periods of ohserwtlon of 12 weeks, w,hlle few data on the long-term result\ are available. Thus, the axm of our qtudy was to mvesngate the long-term results of PTNS on patIenta with non-obstructwe urinary retention
patwnts
MATERIAL & METHODS: 44 (35 females, Y males) were enrolled m a 12.week prospective study. All patients had pathologic post-void residual urine (> 100 ml) and were performing intermittent cathkteris&ions. All patients showed a urodynamic pattern of detrusor undera&ivity, with no sign of bladder outlet obstruction. Stimulation was performed weekly, according to the Staller technique. At 0 and 12 weeks voiding diary and quality of life questionnaire (SF-36) were completed Patients showing a reduction >50% of the total residual unne (catheterised urine per 24 h, keepmg constant the number of catheterisation dunng the I2 weeks) were considered responders and were treated with less frequent stimulations. Pabents showing a reduction or a loss of the results after the mcreasr of time behveen stimulations were treated more frequently. Every I2 weeks pattents completed voiding diary and questionnaire on quality of life. Patients showing residual urine of less than 100 ml in one of the dally catheterisatmns were mstructed to abolish this catheterisation. Results at week 0 and 12 and of the last evaluation available for each responder patient have been considered and statistically compared RESULTS: 35144 patlents (79 5%) showed a chmcal unprovement ;-50% and continued the protocol of stimulation after the I2 weeks Mean follow-up of these patients is 13.6 (2-3 I ) months. Results at week 0 and 12 and of the last available evaluation (LAE) for each responder patient are reported IO table. l7i35 patients (48.6%), still maintaining the results obtained, dropped out the protocol for personal reasons. 15/35 patients (42.X%), havmg lost the results of the treatment. needed to he stimulated more frequently. 14135 patients (40%) stopped the regimen of mtermittent catheterisations
Legend: +week I2 vs. meek 0; *LAE vs. week 0
CONCLUSIONS: The tined lead available with the InterStim neurostimulator allows a simpler, percutaneous implant method that minimizes lead migrations in the weeks following placement. European
Urology Supplements 2 (2003) No. 1, pp. 172
CONCLUSIONS: PTNS seems to he an effictive. mmunally m\asive treatment of non-obstructive urinary retent!on. with results lastmg to a mean follow-up of lmore than I3 months. The neccsslty of frequent aud office based stimulation rrssrons 1sthe cause of a large patrents‘dropout.