Introduction

Sacral neuromodulation (SNM) is an effective therapy for non-obstructive urinary retention, refractory urgency/frequency and urgency incontinence, however it may be underutilized in men. There is a dearth of literature on SNM in men, as most male lower urinary tract symptoms (LUTS) research focuses on medical therapy and bladder outlet procedures, offering little guidance about SNM in men. To what extent UDS can yield diagnostic clarity in male LUTS and its role in predicting SNM success in men is unknown. Herein, we analyze how UDS findings relate to SNS utilization in men._x000D_

Methods

A retrospective review of men undergoing SNM procedures from 2011-2015 at our institution was performed. Demographics, comorbidities, prior urologic treatments, SNM indication, and SNM utilization were assessed. Patients were stratified according to UDS ≤12 months before SNM (+UDS) vs. no UDS testing (-UDS). Descriptive statistics characterized the groups, T-test or chi-square tests were used where appropriate, and logistic regression was used to identify clinical and UDS parameters related to SNM outcomes.

Results

56 men underwent SNM therapy and 28 had UDS within the prior year. UDS+ and UDS- men were similar in age and co-morbid conditions. On average, +UDS men had a greater BMI (30.4+6.5 v 27.3+4.6, p 0.045). Rates of prior transurethral prostate procedures were not significantly different (17.9% v 25%) between the groups. _x000D_ Most (N=53) men underwent staged implant, though 3 (+UDS N=2, -UDS N=1) had peripheral nerve evaluation (PNE). All PNE trials were successful, while rates of Stage 1 success (80.8% v 63.0%, p 0.22) and Stage 2 completion (95.2% v 94.1%, p 1.00) did not differ between +UDS or -UDS men. Device revision (21.4% vs. 25%, p 0.75) and explant (17.9% v 14.5%, p 1.00) rates also did not differ by +UDS or -UDS. _x000D_ No stress urinary incontinence (N=0) was noted on UDS in any patient, but detrusor overactivity was present in 50% (N=14) with urgency urinary incontinence in 25% (N=7).UDS findings of obstruction (N=1), poor compliance (N=1), and hypocontracility (N=1) were rare. Rates of Stage 1 success, Stage 2 completion, device revision, and device explant did not differ in the presence or absence of UDS-proven pathology_x000D_

Conclusions

Sacral nerve stimulation is a feasible treatment for men with refractory lower urinary tract symptoms. Neither the performance of urodynamics nor the presence of urodynamically-proven pathology was associated with greater likelihood of progression to stage 2, device revision or explant. Our findings suggest that SNM may be safely and effectively utilized in men without preoperative urodynamics.

Funding

None