Sacral neuromodulation in patients with idiopathic overactive bladder after initial botulinum toxin therapy
Smits MA, Oerlemans D, Marcelissen TA, Van Kerrebroeck PE, De Wachter SG.J Urol. 2013 Jul 17. pii: S0022-5347(13)04893-3. doi: 10.1016/j.juro.2013.07.017. [Epub ahead of print]


Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands.



To evaluate whether patients with overactive bladder and incontinence that discontinued intravesicalbotulinum toxin therapy (BoNTA), can be successfully treated with sacral neuromodulation (SNM).


All patients who were referred to our centre after discontinuation of BoNTA, between 2005 and 2010, have been included in this observational study. All patients underwent test stimulation with SNM, evaluated with voiding diaries. Success was defined as more than 50% improvement in leakage episodes. Successful test stimulation was subsequently followed by a definitive implant. Patient satisfaction with SNM therapy was evaluated one year after the definitive implant.


In total, 20 patients were included: 17 (85%) patients had discontinued BoNTA because of lack of efficacy. Three had been treated successfully with BoNTA, but requested a more permanent solution. The mean interval between the BoNTA and the SNM test stimulation was 23 months. In 14 patients (70%) the test stimulation was successful and they received a definitive implant. Five of the 14 patients even showed a decrease of >90% in leakage episodes. One year after implantation 11 patients (79%) were satisfied with the SNM treatment.


Despite the small sample size this study indicates that patients who are dissatisfied with or fail BoNTA treatment can respond successfully to sacral neuromodulation. The success rate of the test stimulation is comparable to the success rate of patients who have never been treated with BoNTA. The one-year satisfaction rate is comparable to the patients without a history of BoNTA treatment.