43rd Annual Congress of the Italian Urodynamic Society, Rome, Italy, 13th-15th June 2019: Sacral neuromodulation in patients with lower urinary tract symptoms and affected by epilepsy: a multicentre study

Sacral neuromodulation (SNM) may induce changes in cerebral activity linked to bladder and bowel functions, but data are missing in the medical literature about SNM in epileptic patients with lower urinary tract symptoms (LUTS). Aim of the study was to assess efficacy and safety of SNM in epileptic patients. Materials and methods: Seventeen patients (10 women and 7 men, mean age 44.7 years, range 30‐66) affected by epilepsy (11 primary and 6 secondary epilepsies) with severe LUTS have been recruited from four Italian Neurourology Units in a multicentre national study. The study has been approved by the local Ethical Commitees. Severe LUTS were refractory to previous medical treatments: 6 patients had pure empty symptoms requiring intermittent self‐catheterism, 8 patients had storage symptoms, and 3 patients had mixed storage and empty urinary symptoms. Seven patients had also associated bowel dysfunctions. They underwent the first stage neuromodulation implant with tined lead (threshold of perception around 1 mV) and in case of symptom improvement, they were implanted by definitive SNM device (Interstim 2). Results: Eleven out of 17 (64.7%) patients were affected by primitive epilepsy, whereas 6 of them by secondary epilepsy; except for 3 cases of medically refractory epilepsy, the other 14 patients were successfully treated by antiepileptic drugs. Ten patients (59%) were immediately responsive to the first stage test, successfully implanted with Interstim 2 and showed long‐term positive outcomes and improvement of quality of life; first stage stimulation in the other 7 patients (41%) was negative and, particularly, three patients (17.6%) had epileptic seizures during the procedure that was promptly interrupted and they were excluded from definitive implant. The three patients had primitive drug‐controlled epilepsy and were young (mean age 32 years). Interpretation of results: Although no data are available about previous experiences in the literature, this report suggests that SNM may improve symptoms and quality of life among epileptic patients, but it can be associated to neurological complications. Conclusions: SNM may be safely used among patients with epilepsy affected by LUTS refractory to medical treatment with good results in terms of urologic symptoms. Further mapping studies may provide the focal areas involved in the epileptic process during the SNM for future screening of high‐risk patients and may clarify the relationship with dysfunctional brain activity.