Success rates, quality of life, and feasibility of sacral nerve stimulation in elderly patients: 1-year follow-up
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ORIGINAL ARTICLE
Success rates, quality of life, and feasibility of sacral nerve stimulation in elderly patients: 1-year follow-up Roberto Angioli & Roberto Montera & Francesco Plotti & Alessia Aloisi & Eva Montone & Marzio Angelo Zullo
Received: 21 May 2012 / Accepted: 11 August 2012 / Published online: 8 September 2012 # The International Urogynecological Association 2012
Abstract Introduction and hypothesis Urgency urinary incontinence (UUI) frequently occurs in elderly. International guidelines recommend pharmacological therapy as first-line treatment, but elderly do not respond in many cases. The purpose of this study was to report cure rates, quality of life, and feasibility of sacral neurostimulation (SNS) as an alternative option in the elderly. Materials and methods From October 2008 to April 2010, women >65 years with UUI who were refractory to pharmacological treatments were enrolled in this study and underwent SNS. At 12 months after surgery, patients were asked to compile a 3-day voiding diary and a urogynecologic standardized questionnaire: the Overactive Bladder Questionnaire (OAB-q). Results Eighteen patients met our inclusion criteria. Fifteen (83.3 %) underwent implantation of the neuromodulator. Twelve months after surgery, an overall success rate of 83.3 % was registered. A statistically significant difference (P < 0.0001) between baseline and postsurgery OAB-q scores was recorded. Conclusions SNS can be considered an alternative treatment for UUI in older women. Keywords Elderly patients . Sacral neurostimulation . Quality of life . One-year follow-up . Urgency urinary incontinence
R. Angioli : R. Montera : F. Plotti : A. Aloisi : E. Montone : M. A. Zullo (*) Department of Obstetrics and Gynaecology, University of Rome “Campus Bio-Medico”, Via Álvaro del Portillo, 200, 00128 Rome, Italy e-mail: [email protected]
Introduction Urgency urinary incontinence (UUI) is a common health problem in women, and its prevalence increases throughout life. It is estimated that >200 million women worldwide live with this dysfunction, which results in limitations in daily activities and impairment of quality of life (QOL) [1, 2]. Although the incidence and prevalence of UUI are higher in the elderly population, this condition should not be considered a normal or unavoidable part of the aging process [3]. In fact, as reported by a community-based study, UUI average cost among older adults is 2.5- and 2.2-fold greater per year than those for the general population. UUI is furthermore associated with increased mortality and morbidity, higher risk for falls and fractures, and reduced healthrelated QOL (HR-QOL) [4, 5]. International guidelines [6] recommend pharmacological therapy as the first option, but the elderly in many cases (40 %) do not respond [7, 8] or are not compliant with this approach for several reasons, including the concomitant use of many other drugs, side effects, and the economic aspect. Moreover, 65 years and with UUI confirmed at urodynamic evaluation and who experienced adverse effects or
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