Open Access

ARTICLE

Outcomes of sacral neuromodulation in male patients with overactive bladder, chronic pelvic pain, and fecal incontinence

Roseanne Ferreira¹, Emad Alwashmi^1,2, Samuel Otis-Chapados¹, Naeem Bhojani³, Kevin C. Zorn⁴, Bilal Chughtai⁵, Dean S. Elterman¹

1 Division of Urology, University Health Network, Toronto, Ontario, Canada
2 Department of Surgery, College of Medicine, Qassim University, Qassim, Saudi Arabia
3 Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
4 BPHCanada Prostate Center, Mont-Royal Surgical Center, Montreal, Quebec, Canada
5 Smith Institute of Urology, Plainview Hospital, Northwell Health, Syosset, New York, USA
Address correspondence to Dr. Dean S. Elterman, Division of Urology, Department of Surgery, University of Toronto, 399 Bathurst Street, MP-8-317, Toronto, ON M5T 2S8 Canada

Canadian Journal of Urology 2024, 31(4), 11943-11949.

Abstract

Introduction: Despite the growing body of literature on sacral neuromodulation (SNM) outcomes, research focusing on male patients remains limited and often represented by small cohorts nested within a larger study of mostly women. Herein, we evaluated the outcomes of SNM in a male-only cohort with overactive bladder (OAB), fecal incontinence (FI), chronic bladder pain, and neurogenic lower urinary tract dysfunction (NLUTD).
Materials and methods: This retrospective cohort study included 64 male patients who underwent SNM insertion between 2013 and 2021 at a high-volume tertiary center. Indications for SNM therapy included OAB, FI, chronic pelvic pain, and NLUTD. Descriptive statistics, Fisher’s and t-test were used in analysis.
Results: The mean age was 57.7 ± 13.4 years, and the most frequent reason for SNM insertion was idiopathic OAB (72%), FI (16%), pelvic pain (11%), and NLUTD (11%). A majority (84%) of men received treatment prior to SNM insertion. 84% reported satisfaction and 92% symptom improvement within the first year, and these improvements persisted beyond 1 year in 73% of patients. Mean follow up was 52.7 ± 21.0 months. The complication rate was 23%, and the need for adjunct treatments was significantly reduced (73% to 27%, p < 0.001). Treatment outcomes did not differ significantly between various indications for SNM therapy or the presence of benign prostatic hyperplasia (BPH).
Conclusion: SNM is an effective and safe procedure for male patients with neurogenic and non-neurogenic OAB, pelvic pain, and FI. Over 70% of patients experienced symptomatic improvement and remained satisfied in the mid to long term follow up. BPH does not seem to hinder treatment outcomes.

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