Skip to main content
Top
Published in: BMC Urology 1/2020

01-12-2020 | Overactive Bladder | Research article

Does age alone negatively predict the outcome of sacral neuromodulation? A single-centre retrospective observational study

Authors: Sandra Schönburg, Tobias Bukethal, Paolo Fornara

Published in: BMC Urology | Issue 1/2020

Login to get access

Abstract

Background

For patients over the age of 70 years, sacral neuromodulation (SNM) is often not considered a potential therapeutic option. We therefore report on our results from performing SNM in elderly patients ≥70 years.

Methods

Between 01/09 and 12/18, a total of 95 patients with refractory overactive bladder (OAB) or chronic non-obstructive urinary retention underwent SNM testing at our department. In the overall sample, 20 patients were aged 70 years or older (21%, group B), and 75 patients were under 70 years old (79%, group A). The mean follow-up period was 50.2 ± 36.2 months. Pre-, peri- and postoperative parameters were compared between the two groups. Statistical analysis was carried out with SPSS 25.0 (p < 0.05).

Results

The mean patient age was 53 ± 16 (17–76) years. The indications for SNM testing were OAB and retention in 51 and 49% of patients, respectively. A total of 56 patients (59%) [8 patients (40%) in group B, 48 patients (64%) in group A] had more than 50% improvement in the context of the test (stage 1), such that a permanent neuromodulator (stage 2) was implanted. A total of 14 patients, all under 70 years old except for one older female, needed to undergo revision due to defects or infection. Overall, the success rate was 58.3% for OAB and 59.6% for urinary retention. The success rates and complications in our patient group were independent of age and geriatric assessment.

Conclusion

SNM can also be successfully implemented in older patients.
Appendix
Available only for authorised users
Literature
1.
go back to reference Luyten W, Antal P, Braeckman BP, Bundy J, Cirulli F, Fang-Yen C, Fuellen G, Leroi A, Liu Q, Martorell P, Metspalu A, Perola M, Ristow M, Saul N, Schoofs L, Siems K, Temmerman L, Smets T, Wolk A, Rattan SI. Ageing with elegans: a research proposal to map healthspan pathways. Biogerontology. 2016;17(4):771–82.CrossRef Luyten W, Antal P, Braeckman BP, Bundy J, Cirulli F, Fang-Yen C, Fuellen G, Leroi A, Liu Q, Martorell P, Metspalu A, Perola M, Ristow M, Saul N, Schoofs L, Siems K, Temmerman L, Smets T, Wolk A, Rattan SI. Ageing with elegans: a research proposal to map healthspan pathways. Biogerontology. 2016;17(4):771–82.CrossRef
2.
go back to reference Pratt TS, Suskind AM. Management of overactive bladder in older women. Curr Urol Rep. 2018;19(11):92–105.CrossRef Pratt TS, Suskind AM. Management of overactive bladder in older women. Curr Urol Rep. 2018;19(11):92–105.CrossRef
3.
go back to reference Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36.CrossRef Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36.CrossRef
5.
go back to reference Kose E, Hirai T, Seki T, Yasuno N. Anticholinergic load and nutritional status in older individuals. J Nutr Health Aging. 2020;24(1):20–7.CrossRef Kose E, Hirai T, Seki T, Yasuno N. Anticholinergic load and nutritional status in older individuals. J Nutr Health Aging. 2020;24(1):20–7.CrossRef
6.
go back to reference Yamada S, Ito Y, Nishijima S, Kadekawa K, Sugaya K. Basic and clinical aspects of antimuscarinic agents used to treat overactive bladder. Pharmacol Ther. 2018;189:130–48.CrossRef Yamada S, Ito Y, Nishijima S, Kadekawa K, Sugaya K. Basic and clinical aspects of antimuscarinic agents used to treat overactive bladder. Pharmacol Ther. 2018;189:130–48.CrossRef
7.
go back to reference Pagoria D, O'Connor RC, Guralnick ML. Antimuscarinic drugs: review of the cognitive impact when used to treat overactive bladder in elderly patients. Curr Urol Rep. 2011;12(5):351–7.CrossRef Pagoria D, O'Connor RC, Guralnick ML. Antimuscarinic drugs: review of the cognitive impact when used to treat overactive bladder in elderly patients. Curr Urol Rep. 2011;12(5):351–7.CrossRef
8.
go back to reference Goldman HB, Lloyd JC, Noblett KL, Carey MP, Castaño Botero JC, Gajewski JB, Lehur PA, Hassouna MM, Matzel KE, Paquette IM, de Wachter S, Ehlert MJ, Chartier-Kastler E, Siegel SW. International continence society best practice statement for use of sacral neuromodulation. Neurourol Urodyn. 2018;37(5):1823–48.CrossRef Goldman HB, Lloyd JC, Noblett KL, Carey MP, Castaño Botero JC, Gajewski JB, Lehur PA, Hassouna MM, Matzel KE, Paquette IM, de Wachter S, Ehlert MJ, Chartier-Kastler E, Siegel SW. International continence society best practice statement for use of sacral neuromodulation. Neurourol Urodyn. 2018;37(5):1823–48.CrossRef
9.
go back to reference Anger JT, Cameron AP, Madison R, Saigal C, Clemens JQ, Urologic Diseases in America Project. Predictors of implantable pulse generator placement after sacral neuromodulation: who does better? Neuromodulation. 2014;17(4):381–4.CrossRef Anger JT, Cameron AP, Madison R, Saigal C, Clemens JQ, Urologic Diseases in America Project. Predictors of implantable pulse generator placement after sacral neuromodulation: who does better? Neuromodulation. 2014;17(4):381–4.CrossRef
10.
go back to reference Lee EW, Lee UJ, Lucioni A, Kobashi KC. Outcomes of sacral neuromodulation for overactive bladder in octogenarian females. Urol Prac. 2015;2:22–5.CrossRef Lee EW, Lee UJ, Lucioni A, Kobashi KC. Outcomes of sacral neuromodulation for overactive bladder in octogenarian females. Urol Prac. 2015;2:22–5.CrossRef
11.
go back to reference Faris AER, Gill BC, Pizarro-Berdichevsky J, Dielubanza E, Clifton MM, Okafor H, Goldman HB, Moore CK, Rackley RR, Vasavada SP. Impact of age and comorbidities on use of sacral Neuromodulation. J Urol. 2017;198(1):161–6.CrossRef Faris AER, Gill BC, Pizarro-Berdichevsky J, Dielubanza E, Clifton MM, Okafor H, Goldman HB, Moore CK, Rackley RR, Vasavada SP. Impact of age and comorbidities on use of sacral Neuromodulation. J Urol. 2017;198(1):161–6.CrossRef
12.
go back to reference Greenberg DR, Syan R, Young-Lin N, Comiter CV, Enemchukwu E. Outcomes of sacral nerve stimulation for treatment of refractory overactive bladder among octogenarians. Neuromodulation. 2019;22(6):738–44.CrossRef Greenberg DR, Syan R, Young-Lin N, Comiter CV, Enemchukwu E. Outcomes of sacral nerve stimulation for treatment of refractory overactive bladder among octogenarians. Neuromodulation. 2019;22(6):738–44.CrossRef
13.
go back to reference Głuszewska A, Gryglewska B, Górski S, Kańtoch A, Grodzicki T. Identification of seniors at risk scale as a simple tool of elderly patients’ assessment in an acute hospital department. Folia Med Cracov. 2017;57(2):5–14.PubMed Głuszewska A, Gryglewska B, Górski S, Kańtoch A, Grodzicki T. Identification of seniors at risk scale as a simple tool of elderly patients’ assessment in an acute hospital department. Folia Med Cracov. 2017;57(2):5–14.PubMed
14.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRef
15.
go back to reference Gong G, Wan W, Zhang X, Liu Y, Liu X, Yin J. Correlation between the Charlson comorbidity index and skeletal muscle mass/physical performance in hospitalized older people potentially suffering from sarcopenia. BMC Geriatr. 2019;19(1):367–75.CrossRef Gong G, Wan W, Zhang X, Liu Y, Liu X, Yin J. Correlation between the Charlson comorbidity index and skeletal muscle mass/physical performance in hospitalized older people potentially suffering from sarcopenia. BMC Geriatr. 2019;19(1):367–75.CrossRef
16.
go back to reference Bo M, Cacello E, Ghiggia F, Corsinovi L, Bosco F. Predictive factors of clinical outcome in older surgical patients. Arch Gerontol Geriatr. 2007;44(3):215–24.CrossRef Bo M, Cacello E, Ghiggia F, Corsinovi L, Bosco F. Predictive factors of clinical outcome in older surgical patients. Arch Gerontol Geriatr. 2007;44(3):215–24.CrossRef
17.
go back to reference Wöllner J, Hampel C, Kessler TM. Surgery illustrated – surgical atlas sacral neuromodulation. BJU Int. 2012;110(1):146–59.CrossRef Wöllner J, Hampel C, Kessler TM. Surgery illustrated – surgical atlas sacral neuromodulation. BJU Int. 2012;110(1):146–59.CrossRef
18.
go back to reference Matzel KE, Chartier-Kastler E, Knowles CH, Lehur PA, Muñoz-Duyos A, Ratto C, Rydningen MB, Sørensen M, van Kerrebroeck P, de Wachter S. Sacral neuromodulation: standardized electrode placement technique. Neuromodulation. 2017;20(8):816–24.CrossRef Matzel KE, Chartier-Kastler E, Knowles CH, Lehur PA, Muñoz-Duyos A, Ratto C, Rydningen MB, Sørensen M, van Kerrebroeck P, de Wachter S. Sacral neuromodulation: standardized electrode placement technique. Neuromodulation. 2017;20(8):816–24.CrossRef
19.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications. Ann Surg. 2004;240(2):205–13.CrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications. Ann Surg. 2004;240(2):205–13.CrossRef
20.
go back to reference Idriss AM, Tfeil Y, Baba JS, Boukhary SM, Deddah MA. Applicability of the Clavien-Dindo classification in the evaluation of postoperative complications at the Surgery Department of the National Hospital Center of Nouakchott: observational study of 834 cases. Pan Afr Med J. 2019;33:254.CrossRef Idriss AM, Tfeil Y, Baba JS, Boukhary SM, Deddah MA. Applicability of the Clavien-Dindo classification in the evaluation of postoperative complications at the Surgery Department of the National Hospital Center of Nouakchott: observational study of 834 cases. Pan Afr Med J. 2019;33:254.CrossRef
21.
go back to reference Van Kerrebroeck PE, Marcelissen TA. Sacral neuromodulation for lower urinary tract dysfunction. World J Urol. 2012;30(4):445–550.CrossRef Van Kerrebroeck PE, Marcelissen TA. Sacral neuromodulation for lower urinary tract dysfunction. World J Urol. 2012;30(4):445–550.CrossRef
22.
go back to reference Ammirati E, Giammò A, Manassero A, Carone R. Neuromodulation in urology, state of the art. Urologia. 2019;86(4):177–82.CrossRef Ammirati E, Giammò A, Manassero A, Carone R. Neuromodulation in urology, state of the art. Urologia. 2019;86(4):177–82.CrossRef
24.
go back to reference O'Caoimh R, Costello M, Small C, Spooner L, Flannery A, O'Reilly L, Heffernan L, Mannion E, Maughan A, Joyce A, Molloy DW, O'Donnell J. Comparison of frailty screening instruments in the emergency department. Int J Environ Res Public Health. 2019;16(19):3626.CrossRef O'Caoimh R, Costello M, Small C, Spooner L, Flannery A, O'Reilly L, Heffernan L, Mannion E, Maughan A, Joyce A, Molloy DW, O'Donnell J. Comparison of frailty screening instruments in the emergency department. Int J Environ Res Public Health. 2019;16(19):3626.CrossRef
25.
go back to reference Amundsen CL, Romero AA, Jamison MG, Webster GD. Sacral neuromodulation for intractable urge incontinence: are there factors associated with cure? Urology. 2005;66(4):746–50.CrossRef Amundsen CL, Romero AA, Jamison MG, Webster GD. Sacral neuromodulation for intractable urge incontinence: are there factors associated with cure? Urology. 2005;66(4):746–50.CrossRef
26.
go back to reference Scharf AC, Gronewold J, Dahlmann C, Schlitzer J, Kribben A, Gerken G, Rassaf T, Kleinschnitz C, Dodel R, Frohnhofen H, Hermann DM. Health outcome of older hospitalized patients in internal medicine environments evaluated by Identification of Seniors at Risk (ISAR) screening and geriatric assessment. BMC Geriatr. 2019;19(1):221–32.CrossRef Scharf AC, Gronewold J, Dahlmann C, Schlitzer J, Kribben A, Gerken G, Rassaf T, Kleinschnitz C, Dodel R, Frohnhofen H, Hermann DM. Health outcome of older hospitalized patients in internal medicine environments evaluated by Identification of Seniors at Risk (ISAR) screening and geriatric assessment. BMC Geriatr. 2019;19(1):221–32.CrossRef
27.
go back to reference Gurlit S, Möllmann H. Preoperative risk identification using the identification of seniors at risk?: suitability as sole screening tool for inpatient aged risk patients. Z Gerontol Geriatr. 2018;51(4):388–93.CrossRef Gurlit S, Möllmann H. Preoperative risk identification using the identification of seniors at risk?: suitability as sole screening tool for inpatient aged risk patients. Z Gerontol Geriatr. 2018;51(4):388–93.CrossRef
28.
go back to reference Brazzelli M, Murray A, Fraser C. Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. J Urol. 2016;175:835–41.CrossRef Brazzelli M, Murray A, Fraser C. Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. J Urol. 2016;175:835–41.CrossRef
29.
go back to reference Noblett K, Siegel S, Mangel J, Griebling TL, Sutherland SE, Bird ET, Comiter C, Culkin D, Bennett J, Zylstra S, Kan F, Berg KC. Results of a prospective, multicenter study evaluating quality of life, safety, and efficacy of sacral neuromodulation at twelve months in subjects with symptoms of overactive bladder. NeurourolUrodyn. 2016;35:246–51. Noblett K, Siegel S, Mangel J, Griebling TL, Sutherland SE, Bird ET, Comiter C, Culkin D, Bennett J, Zylstra S, Kan F, Berg KC. Results of a prospective, multicenter study evaluating quality of life, safety, and efficacy of sacral neuromodulation at twelve months in subjects with symptoms of overactive bladder. NeurourolUrodyn. 2016;35:246–51.
30.
go back to reference Chughtai B, Sedrakyan A, Isaacs A, Lee R, Te A, Kaplan S. Long term safety of sacral nerve modulation in Medicare beneficiaries. NeurourolUrodyn. 2015;34:659–63. Chughtai B, Sedrakyan A, Isaacs A, Lee R, Te A, Kaplan S. Long term safety of sacral nerve modulation in Medicare beneficiaries. NeurourolUrodyn. 2015;34:659–63.
Metadata
Title
Does age alone negatively predict the outcome of sacral neuromodulation? A single-centre retrospective observational study
Authors
Sandra Schönburg
Tobias Bukethal
Paolo Fornara
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2020
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/s12894-020-00621-6

Other articles of this Issue 1/2020

BMC Urology 1/2020 Go to the issue