Öz
Amaç: Sakral nöromodülasyon (SNM), çeşitli alt üriner sistem disfonksiyonları için minimal invaziv bir tedavi seçeneğidir. Yaygın kullanımına rağmen, etki mekanizması ve ideal hasta seçimi hâlâ tam olarak net değildir. Bu çalışma, Türkiye'deki üçüncü basamak sağlık merkezlerinde SNM uygulanan hastaların sonuçlarını raporlamayı amaçlamaktadır.
Gereç ve Yöntem 2017–2022 yılları arasında üriner disfonksiyon, barsak disfonksiyonu veya kronik pelvik ağrı nedeniyle SNM uygulanan 16 hastanın retrospektif analizi yapıldı. Hastaların demografik özellikleri, tanıları, implantasyon süresi, komplikasyonlar ve semptom iyileşmeleri kaydedildi. Üriner fonksiyonlar, Uluslararası İnkontinans Danışma Anketi-Kısa Formu (ICIQ-SF) kullanılarak değerlendirildi. İstatistiksel analizler SPSS Statistics 26.0 programı ile gerçekleştirildi.
Bulgular: Hastaların ortalama yaşı 42,4±11,9 yıl, ortalama vücut kitle indeksi 25,5±5,4 kg/m² idi. Semptom süresi ortalama 12,6±10,5 yıl, implantasyon yaşı ise 40,2±11,1 yıl olarak saptandı. SNM uygulamaları esas olarak idiyopatik mesane disfonksiyonu (%87,5) ve fekal inkontinans (%12,5) nedeniyle gerçekleştirildi. Ortalama ICIQ-SF semptom skoru, implantasyon öncesi 13,64±7,61 iken, implantasyon sonrası 7,50±7,51'ye düşerek anlamlı şekilde azaldı (p=0,003). Cerrahi müdahale gerektiren komplikasyonlar hastaların %12,5’inde gözlendi.
Sonuç: Çalışmamız, SNM’nin üriner ve barsak disfonksiyonlarıyla ilişkili semptomları iyileştirmede etkili olduğunu göstermektedir; bu, ICIQ-SF skorlarındaki anlamlı düşüşle desteklenmektedir. Bununla birlikte, dikkat çekici düzeyde komplikasyon oranı, hasta seçiminin ve tedavi sürecinin dikkatli şekilde yönetilmesinin önemini ortaya koymaktadır. Farklı hasta gruplarında SNM'nin uzun vadeli etkinliğini ve güvenilirliğini değerlendirmek için daha geniş örneklem grupları ve daha uzun takip sürelerine sahip ileri çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
Sakral nöromodülasyon aşırı aktif mesane üriner inkontinans fekal inkontinans alt üriner sistem disfonksiyonu
Kaynakça
- Goldman HB, Lloyd JC, Noblett KL, et al. International Continence Society best practice statement for use of sacral neuromodulation. Neurourology and urodynamics. 2018;37(5):1823-1848.
- Phillips A. Sacral neuromodulation system for treating refractory overactive bladder. British Journal of Nursing. 2020;29(18):S30-S37.
- Gill BC, Pizarro-Berdichevsky J, Bhattacharyya PK, et al. Real-time changes in brain activity during sacral neuromodulation for overactive bladder. The Journal of urology. 2017;198(6):1379-1385.
- Mass-Lindenbaum M, Calderón-Pollak D, Goldman H, Pizarro-Berdichevsky J. Sacral neuromodulation-when and for who. International braz j urol. 2021;47:647-656.
- Averbeck MA, Gomes CM. Worldwide utilization patterns of sacral neuromodulation for neurogenic lower urinary tract dysfunction. Current Bladder Dysfunction Reports. 2016;11(4):356-364.
- Hu M, Lai S, Zhang Y, Liu M, Wang J. Sacral neuromodulation for lower urinary tract dysfunction in spinal cord injury: a systematic review and meta-analysis. Urologia Internationalis. 2019;103(3):337-343.
- Tutolo M, Ammirati E, Heesakkers J, et al. Efficacy and safety of sacral and percutaneous tibial neuromodulation in non-neurogenic lower urinary tract dysfunction and chronic pelvic pain: a systematic review of the literature. European Urology. 2018;73(3):406-418.
- van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. The Journal of urology. 2007;178(5):2029-2034.
- Averbeck MA, Moreno-Palacios J, Aparicio A. Is there a role for sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction? International braz j urol. 2020;46:891-901.
- Gormley E, Lightner D, Burgio K, et al. Diagnosis and treatment of non-neurogenic overactive bladder (OAB) in adults: an AUA/SUFU guideline (2019). 2020:
- Nambiar AK, Arlandis S, Bø K, et al. European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence. European Urology. 2022;
- Siegel S, Noblett K, Mangel J, et al. Results of a prospective, randomized, multicenter study evaluating sacral neuromodulation with InterStim therapy compared to standard medical therapy at 6-months in subjects with mild symptoms of overactive bladder. Neurourol Urodyn. Mar 2015;34(3):224-30. doi:10.1002/nau.22544
- Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. Apr 2010;183(4):1438-43. doi:10.1016/j.juro.2009.12.036
- Spinelli M, Sievert KD. Latest technologic and surgical developments in using InterStim Therapy for sacral neuromodulation: impact on treatment success and safety. Eur Urol. Dec 2008;54(6):1287-96. doi:10.1016/j.eururo.2008.01.076
- Alghafees M, Ghazwani Y, Alqahtani M, Aldarrab R. Trends and Outcomes of Sacral Neuromodulation: A Saudi Tertiary Care Center Experience. Journal of Urological Surgery. 2022;9(1):25.
- Al-Azzawi IS, Al-Tamimi MA. The first Iraqi experience in sacral neuromodulation for patients with lower urinary tract dysfunction. Arab Journal of Urology. 2018;16(4):391-396.
- Shehab Z, Yaiesh S, Al-Terki A, Al-Shaiji T. [33] Sacral neuromodulation: Report of initial experience in Kuwait. Arab Journal of Urology. 2018;16(sup1):S16-S17.
- van Wunnik BP, Govaert B, Leong R, Nieman FH, Baeten CG. Patient experience and satisfaction with sacral neuromodulation: results of a single-center sample survey. Diseases of the colon & rectum. 2011;54(1):95-100.
- Gandhi S, Gajewski JB, Koziarz A, Almutairi S, Ali A, Cox A. Long‐term outcomes of sacral neuromodulation for lower urinary tract dysfunction: A 23‐year experience. Neurourology and Urodynamics. 2021;40(1):461-469.
- Al-Zahrani AA, Elzayat EA, Gajewski JB. Long-term outcome and surgical interventions after sacral neuromodulation implant for lower urinary tract symptoms: 14-year experience at 1 center. The Journal of urology. 2011;185(3):981-986.
- Kessler TM, Buchser E, Meyer S, et al. Sacral neuromodulation for refractory lower urinary tract dysfunction: results of a nationwide registry in Switzerland. Eur Urol. May 2007;51(5):1357-63. doi:10.1016/j.eururo.2006.11.011
- Laviana A, Jellison F, Kim JH. Sacral neuromodulation for refractory overactive bladder, interstitial cystitis, and painful bladder syndrome. Neurosurg Clin N Am. Jan 2014;25(1):33-46. doi:10.1016/j.nec.2013.08.001
- Ammirati E, Giammò A, Manassero A, Carone R. Neuromodulation in urology, state of the art. Urologia Journal. 2019;86(4):177-182.
- Siddiqui NY, Wu JM, Amundsen CL. Efficacy and adverse events of sacral nerve stimulation for overactive bladder: a systematic review. Neurourology and urodynamics. 2010;29(S1):S18-S23.
- Jonas U, Fowler CJ, Chancellor MB, et al. Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol. Jan 2001;165(1):15-9. doi:10.1097/00005392-200101000-00004
- Siegel SW, Catanzaro F, Dijkema HE, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology. 2000;56(6):87-91.
- Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. J Urol. Sep 2019;202(3):558-563. doi:10.1097/ju.0000000000000309
- Thüroff JW, Abrams P, Andersson K-E, et al. EAU guidelines on urinary incontinence. Actas Urológicas Españolas (English Edition). 2011;35(7):373-388.
Öz
Aim: Sacral neuromodulation (SNM) is a minimally invasive treatment option for various lower urinary tract symptoms (LUTS) and bowel dysfunctions. Despite its widespread use, the exact mechanism of action and optimal patient selection remain unclear. This study aimed to report the outcomes of SNM in patients treated at tertiary health centers in Türkiye.
Materials and Methods: A retrospective analysis was conducted on 16 patients who underwent SNM for LUTS, bowel dysfunction, or chronic pelvic pain between 2017 and 2022. Patient characteristics, primary diagnosis, implantation duration, complications, and symptom improvement were recorded. Urinary symptoms were assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Statistical analyses were performed using SPSS Statistics 26.0.
Results: The mean age of the patients was 42.4 ± 11.9 years, with a mean BMI of 25.5 ± 5.4 kg/m². The mean duration of symptoms was 12.6 ± 10.5 years, and the mean age at implantation was 40.2 ± 11.1 years. SNM was primarily performed for idiopathic lower urinary tract dysfunction (87.5% of patients) and faecal incontinence (12.5%). The mean ICIQ-SF score significantly decreased from 13.64 ± 7.61 before implantation to 7.50 ± 7.51 after implantation (p = 0.003). A complication requiring surgical intervention occurred in 12.5% of patients.
Conclusion: This study demonstrates that SNM is effective in improving symptoms associated with LUTS and bowel dysfunction, as evidenced by the significant reduction in ICIQ-SF scores. However, a notable complication rate was observed, highlighting the importance of appropriate patient selection and ongoing follow-up. Further studies with larger cohorts and longer follow-up are warranted to evaluate the long-term outcomes and safety profile of SNM.
Anahtar Kelimeler
Keywords: Sacral neuromodulation overactive bladder urinary incontinence fecal incontinence Lower urinary tract dysfunction
Kaynakça
- Goldman HB, Lloyd JC, Noblett KL, et al. International Continence Society best practice statement for use of sacral neuromodulation. Neurourology and urodynamics. 2018;37(5):1823-1848.
- Phillips A. Sacral neuromodulation system for treating refractory overactive bladder. British Journal of Nursing. 2020;29(18):S30-S37.
- Gill BC, Pizarro-Berdichevsky J, Bhattacharyya PK, et al. Real-time changes in brain activity during sacral neuromodulation for overactive bladder. The Journal of urology. 2017;198(6):1379-1385.
- Mass-Lindenbaum M, Calderón-Pollak D, Goldman H, Pizarro-Berdichevsky J. Sacral neuromodulation-when and for who. International braz j urol. 2021;47:647-656.
- Averbeck MA, Gomes CM. Worldwide utilization patterns of sacral neuromodulation for neurogenic lower urinary tract dysfunction. Current Bladder Dysfunction Reports. 2016;11(4):356-364.
- Hu M, Lai S, Zhang Y, Liu M, Wang J. Sacral neuromodulation for lower urinary tract dysfunction in spinal cord injury: a systematic review and meta-analysis. Urologia Internationalis. 2019;103(3):337-343.
- Tutolo M, Ammirati E, Heesakkers J, et al. Efficacy and safety of sacral and percutaneous tibial neuromodulation in non-neurogenic lower urinary tract dysfunction and chronic pelvic pain: a systematic review of the literature. European Urology. 2018;73(3):406-418.
- van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. The Journal of urology. 2007;178(5):2029-2034.
- Averbeck MA, Moreno-Palacios J, Aparicio A. Is there a role for sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction? International braz j urol. 2020;46:891-901.
- Gormley E, Lightner D, Burgio K, et al. Diagnosis and treatment of non-neurogenic overactive bladder (OAB) in adults: an AUA/SUFU guideline (2019). 2020:
- Nambiar AK, Arlandis S, Bø K, et al. European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence. European Urology. 2022;
- Siegel S, Noblett K, Mangel J, et al. Results of a prospective, randomized, multicenter study evaluating sacral neuromodulation with InterStim therapy compared to standard medical therapy at 6-months in subjects with mild symptoms of overactive bladder. Neurourol Urodyn. Mar 2015;34(3):224-30. doi:10.1002/nau.22544
- Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. Apr 2010;183(4):1438-43. doi:10.1016/j.juro.2009.12.036
- Spinelli M, Sievert KD. Latest technologic and surgical developments in using InterStim Therapy for sacral neuromodulation: impact on treatment success and safety. Eur Urol. Dec 2008;54(6):1287-96. doi:10.1016/j.eururo.2008.01.076
- Alghafees M, Ghazwani Y, Alqahtani M, Aldarrab R. Trends and Outcomes of Sacral Neuromodulation: A Saudi Tertiary Care Center Experience. Journal of Urological Surgery. 2022;9(1):25.
- Al-Azzawi IS, Al-Tamimi MA. The first Iraqi experience in sacral neuromodulation for patients with lower urinary tract dysfunction. Arab Journal of Urology. 2018;16(4):391-396.
- Shehab Z, Yaiesh S, Al-Terki A, Al-Shaiji T. [33] Sacral neuromodulation: Report of initial experience in Kuwait. Arab Journal of Urology. 2018;16(sup1):S16-S17.
- van Wunnik BP, Govaert B, Leong R, Nieman FH, Baeten CG. Patient experience and satisfaction with sacral neuromodulation: results of a single-center sample survey. Diseases of the colon & rectum. 2011;54(1):95-100.
- Gandhi S, Gajewski JB, Koziarz A, Almutairi S, Ali A, Cox A. Long‐term outcomes of sacral neuromodulation for lower urinary tract dysfunction: A 23‐year experience. Neurourology and Urodynamics. 2021;40(1):461-469.
- Al-Zahrani AA, Elzayat EA, Gajewski JB. Long-term outcome and surgical interventions after sacral neuromodulation implant for lower urinary tract symptoms: 14-year experience at 1 center. The Journal of urology. 2011;185(3):981-986.
- Kessler TM, Buchser E, Meyer S, et al. Sacral neuromodulation for refractory lower urinary tract dysfunction: results of a nationwide registry in Switzerland. Eur Urol. May 2007;51(5):1357-63. doi:10.1016/j.eururo.2006.11.011
- Laviana A, Jellison F, Kim JH. Sacral neuromodulation for refractory overactive bladder, interstitial cystitis, and painful bladder syndrome. Neurosurg Clin N Am. Jan 2014;25(1):33-46. doi:10.1016/j.nec.2013.08.001
- Ammirati E, Giammò A, Manassero A, Carone R. Neuromodulation in urology, state of the art. Urologia Journal. 2019;86(4):177-182.
- Siddiqui NY, Wu JM, Amundsen CL. Efficacy and adverse events of sacral nerve stimulation for overactive bladder: a systematic review. Neurourology and urodynamics. 2010;29(S1):S18-S23.
- Jonas U, Fowler CJ, Chancellor MB, et al. Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol. Jan 2001;165(1):15-9. doi:10.1097/00005392-200101000-00004
- Siegel SW, Catanzaro F, Dijkema HE, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology. 2000;56(6):87-91.
- Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. J Urol. Sep 2019;202(3):558-563. doi:10.1097/ju.0000000000000309
- Thüroff JW, Abrams P, Andersson K-E, et al. EAU guidelines on urinary incontinence. Actas Urológicas Españolas (English Edition). 2011;35(7):373-388.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ağrı |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Gönderilme Tarihi | 3 Haziran 2025 |
| Kabul Tarihi | 24 Ekim 2025 |
| Yayımlanma Tarihi | 9 Mart 2026 |
| DOI | https://doi.org/10.19161/etd.1712538 |
| IZ | https://izlik.org/JA67PF99DN |
| Yayımlandığı Sayı | Yıl 2026 Cilt: 65 Sayı: 1 |
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