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abstract

417 - THE IMPACT OF SACRAL NEUROMODULATION ON SEXUAL FUNCTION

417

THE IMPACT OF SACRAL NEUROMODULATIONON SEXUAL FUNCTION

P. S. OLIVEIRA, T. R. OLIVEIRA,R. P. SILVA, D. MARTINHO, J. P. REIS, T. M. LOPES;
Department ofUrology,, Hosp. de Santa Maria, Lisbon, Portugal.

Introduction: Sacralneuromodulation (SNM) has become an established option in thetreatment of refractory overactive bladder, frequency-urgencysyndrome, non-obstructive urinary retention, and chronic fecalincontinence. Additional benefits have been reported in chronicpelvic pain and sexual dysfunction.
Objective: The aim ofthis study was to evaluate the impact of SNM on sexual function ofpatients who underwent implantation of a sacralneurostimulator.
Methods: A retrospective analysis wasperformed in our center of all patients who underwent SNM therapy,from May 2012 to August 2016. Sexual function was assessed in allsexually active individuals, before surgery and postoperatively. Menwere assessed with the International Index of Erectile Function(IIEF-5). Women were assessed with the Female Sexual Function Index(FSFI).
Results: Of the 49 patients who underwent stage-1SNM, 34 were permanently implanted. Five patients had no activesexual life and were excluded. Another 5 patients missed scheduledfollow-up and were excluded. Twenty-four patients were included, 15females (62.5%) and 9 males (37.5%), with a median age of 41 years(26-72), 10 patients <40 years-old (yo) (41.7%) and 14 patients>40 yo (58.3%). Regarding functional diagnosis, 12 patients (50%)had urinary retention (UR), 4 patients (16.7%) overactive bladder(OAB), 6 patients (25%) detrusor overactivity with impairedcontractility (UR+OAB), one patient (4.2%)bladder-sphyncter-dyssynergia and one patient (4.2%) fecalincontinence. Median IIEF-5 score before SNM was 10 (Q1=8.5;Q3=22.5), median IIEF-5 after SNM was 17 (Q1=11; Q3=22.5), with 4patients (44.4%) presenting IIEF-5 improvement after SNM. Median FSFItotal score before SNM was 24.1 (Q1=20.3 ; Q3=30.2), median FSFItotal score after SNM was 26.3 (Q1=23.5 ; Q3=30.4), with 5 patients(33.3%) presenting FSFI improvement after SNM. Regarding FSFIspecific domains, two patients (13.3%) presented improvement onDesire after SNM, 3 patients (20%) on Arousal, 5 patients (33.3%) onLubrication (p = 0.04), 4 patients (26.7%) on Orgasm, 3patients (20%) on Satisfaction, and 3 patients (20%) on Pain.Regarding overall sexual function (IIEF-5 and FSFI), 9 patients(37.5%) presented improvement after SNM. Patients <40 yo presented40% of improvement, patients >40 yo, 35.7%. Patients with URpresented 16.7% of improvement, OAB, 25% and UR+OAB, 83.3% (p =0.02). Patients with a PVR (post-void residual urine) before SNM <150mL presented 55.6% of improvement and PVR >150 mL, 25%. Adverseeffects were present in 9 patients (37.5%), being lead migration themost common (12,5%).
Conclusions: Even though sexualdysfunction of any type is not currently an indication for SNM, mostpatients in our series present some degree of improvement whendysfunction is present, previously to SNM. The predictive factors forimprovement are unknown but possibly parasympathetic nervesstimulation at S2-S4 roots plays a major role in these patients andit should be the aim of further prospective studies. SNM definitelyplays a role on this pathology, especially in young patients withcomplex functional pathology, for whom sexual function is of utmostimportance for their quality of life.
References: Can UrolAssoc J. 2014;8(11-12):e762-7Neurourology and Urodynamics 2015; 34:456-460Int Urogynecol J 2015; 26: 1751-1757