PMID- 33713279
OWN - NLM
STAT- MEDLINE
DCOM- 20210419
LR  - 20210907
IS  - 1865-8652 (Electronic)
IS  - 0741-238X (Print)
IS  - 0741-238X (Linking)
VI  - 38
IP  - 4
DP  - 2021 Apr
TI  - Systematic Literature Review and Meta-Analysis of Sacral Neuromodulation (SNM) in 
      Patients with Neurogenic Lower Urinary Tract Dysfunction (nLUTD): Over 20 Years' 
      Experience and Future Directions.
PG  - 1987-2006
LID - 10.1007/s12325-021-01650-9 [doi]
AB  - INTRODUCTION: Sacral neuromodulation (SNM) has been used in carefully selected 
      patients with neurogenic lower urinary tract dysfunctions (nLUTD) for over two 
      decades. METHODS: The aim of the current work was to perform a systematic 
      literature review and meta-analysis of studies reporting the safety and 
      effectiveness of SNM in patients with nLUTD (neurogenic detrusor overactivity, 
      non-obstructive urinary retention, or a combination of both). For this purpose a 
      systematic literature research was conducted using Embase (OvidSP), MEDLINE 
      (OvidSP), MEDLINE In-Process Citations & Daily Update (OvidSP), MEDLINE (OvidSP) 
      e-Pub ahead of print, Cochrane Central Register of Controlled Trials (CENTRAL), 
      NIH Clinicaltrials.gov, and WHO International Clinical Trials Registry Platform 
      (ICTRP) between 1998 and March 2020, supplemented by a hand search. RESULTS: 
      Forty-seven studies were included in the systematic literature review. Twenty-one 
      studies comprising a total of 887 patients were included in the meta-analysis of 
      test SNM. The pooled success rate of SNM test stimulation was 66.2% (95% CI 
      56.9-74.4). Depending on neurogenic conditions test success rates varied greatly. 
      Twenty-four studies with a total of 428 patients were included in the 
      meta-analysis of permanent SNM. The success rate of pooled permanent SNM was 
      84.2% (95% CI 77.8-89.0). Among the identified studies, the most common adverse 
      events (AEs) were loss of effectiveness, infection, pain at implant site, and 
      lead migration with AE rates of 4.7%, 3.6%, 3.2%, and 3.2%, respectively. 
      Limitations entail lower level of evidence (Oxford classification 3-4) of 
      included studies, significant risk of bias, small sample sizes in some studies, 
      the inclusion of retrospective case series, substantial between-study 
      heterogeneity, heterogeneous patient populations, insufficient disease 
      classification, and variations in terms of outcome parameters as well as 
      techniques. Furthermore, long-term data are limited. CONCLUSION: This 
      meta-analysis supports not only the benefits of permanent SNM for various nLUTDs 
      but also high overall success rates, similar to idiopathic patients. Current data 
      of the analyzed studies showed that SNM is safe for these patients. However, more 
      vigorous studies and/or registries are needed before definitive conclusions can 
      be drawn.
FAU - van Ophoven, Arndt
AU  - van Ophoven A
AD  - Department of Neuro-Urology, Marien Hospital Herne, University Hospital 
      Ruhr-Universitat Bochum, Bochum, Germany. 
      arndt.vanophoven@marienhospital-herne.de.
FAU - Engelberg, Stefan
AU  - Engelberg S
AD  - Medtronic International, Tolochenaz, Switzerland.
FAU - Lilley, Helen
AU  - Lilley H
AD  - PHMR Ltd., Berkeley Works, Berkley Grove, London, UK.
FAU - Sievert, Karl-Dietrich
AU  - Sievert KD
AD  - Department of Urology, University Hospital OWL Campus Lippe-Detmold, Detmold, 
      Germany.
AD  - Department of Urology, University Hospital Tubingen, Tubingen, Germany.
AD  - Department of Urology, Medical University Vienna, Vienna, Austria.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20210313
PL  - United States
TA  - Adv Ther
JT  - Advances in therapy
JID - 8611864
CIN - Int Braz J Urol. 2021 Nov-Dec;47(6):1264-1265. PMID: 34469676
MH  - *Electric Stimulation Therapy
MH  - Humans
MH  - Lumbosacral Plexus
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - *Urinary Bladder, Overactive/therapy
PMC - PMC8004509
OTO - NOTNLM
OT  - Implantable neurostimulators
OT  - Magnetic resonance imaging
OT  - Meta-analysis
OT  - Neurogenic lower urinary tract dysfunction
OT  - Sacral neuromodulation
EDAT- 2021/03/14 06:00
MHDA- 2021/04/20 06:00
PMCR- 2021/03/13
CRDT- 2021/03/13 12:11
PHST- 2020/12/16 00:00 [received]
PHST- 2021/02/03 00:00 [accepted]
PHST- 2021/03/14 06:00 [pubmed]
PHST- 2021/04/20 06:00 [medline]
PHST- 2021/03/13 12:11 [entrez]
PHST- 2021/03/13 00:00 [pmc-release]
AID - 10.1007/s12325-021-01650-9 [pii]
AID - 1650 [pii]
AID - 10.1007/s12325-021-01650-9 [doi]
PST - ppublish
SO  - Adv Ther. 2021 Apr;38(4):1987-2006. doi: 10.1007/s12325-021-01650-9. Epub 2021 
      Mar 13.