Does sacral nerve modulation work on simultaneous bladder and rectal dysfunctions?

Introduction: Our target was to retrospectively examine the results of Sacral Nerve Modulation (SNM) in patients complaining of simultaneous bladder and the rectum dysfunctions, here called double pelvic dysfunction (DPD). Methods: In 2009, in six Italian centres, patients treated with SNM were asked to complete a self-assessment questionnaire for DPD. The questionnaire investigated the changes in micturition and rectal symptoms after SNM using specific questions for each dysfunction and symptom overactive bladder (OAB), urinary retention (UR), faecal incontinence (FI) and constipation (Co). Results: Data obtained from forty-four patients with a mean follow-up period of 56.9 months were retrospectively analysed. 73% of patients treated with SNM for DPD reported a significant clinical improvement, and in particular we observed an improvement of 68% for UR+Co, 78% for OAB+Co and 75% for OAB+FI. Among the OAB+Co and UR+Co cases a higher percentage showed a clinical improvement in the vesical alterations (100% and 95% respectively) than in the anorectal ones (79% and 68%). In the OAB+FI group, on the other hand, a higher percentage of cases showed improvements in the anorectal alterations (100%) than in the vescical ones (75%). The improvement was confirmed by a reduction in use of devices and incontinence protection products (pads, self-catheterization and laxatives/enemas). Neurogenic patients had a better outcome than the non-neurogenic ones especially in the OAB+FI group (p=0.021). Conclusions: In our survey SNM has been more effective in DPD with FI and OAB, especially in a picture of neurological DPD. Therefore, considering also the economic aspect, SNM seems a viable option in highly selected cases of neurogenic DPD including FI. Retrospectively analysed through a patient self-assessment questionnaire, SNM is effective in simultaneous bladder and rectum dysfunction especially with neurogenic faecal incontinence.