Sacral Neuromodulation in the Treatment of Non-Neurogenic Female Lower Urinary Tract Dysfunction; First Case-series and Systematic Review of Literature

Objective: To demonstrate which types of non-neurogenic female lower urinary tract dysfunction (LUTD) respond to sacral neuromodulation (SNM) after the failure of all non-invasive treatments. Materials and Methods: Female LUTD performed SNM between 2017 and 2019 were retrospectively reviewed. A case with anatomical or neurological abnormalities were excluded by thorough physical examination and investigations. The specific type of LUTD, including midurethral obstruction (MUO), was diagnosed by videourodynamics (VUDS). Clinical diagnoses, including idiopathic urinary retention (IUR), voiding dysfunction (VD) and refractory overactive bladder (OAB), were used instead of VUDS diagnosis when the result was normal or inconclusive. The International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) in Thai version were used to compare between pre and post-treatment. Responder was defined as an IPSS and/or OABSS decreased more than 50% from baseline. Results: Total 21 cases were performed SNM. The average age was 49.6 (24–80) years. The average pre-treatment IPSS and OABSS were 23.4 and 6.4 as well as average post-treatment IPSS and OABSS were 13.7 and 3.8. Only 9 out of 21 cases (42.9%) showed improvement after SNM. The responders included 7 out of 11 MUO (63.6%), 1 out of 4 IUR (25.0%), and 1 out of 3 OAB (33.3%). None of the VD cases responded to SNM. Conclusions: SNM is another option for female patients with LUTD who have failed to respond to conservative treatments. After completely excluding anatomical and neurological abnormalities, the types of LUTD having a chance to respond to SNM are MUO, IUR, and OAB.