Sacral neuromodulation is found efficacious for OAB in male-only cohort

"Male patients are typically underrepresented in clinical trials when it comes to sacral neuromodulation," said Dean Elterman, MD, MSc, FRCSC.

Dean Elterman, MD, MSc, FRCSC and colleagues recently looked at the use of sacral neuromodulation (SNM) to treat overactive bladder (OAB), fecal incontinence, and chronic pain in male patients. The studies,^1,2 presented at the Northeastern Section of the American Urological Association Annual Meeting, found high levels of satisfaction and efficacy in patients who underwent sacral neuromodulation for OAB and fecal incontinence. Elterman discusses these findings further in the following interview conducted with Urology Times®.

Could you describe the background for this study?

The background for our study was essentially to look at the outcomes of sacral neuromodulation in a cohort of male patients. This is interesting because male patients are typically underrepresented in clinical trials when it comes to sacral neuromodulation, and they don't receive sacral neuromodulation as often as women. So probably, at least in my practice, men represent about less than 10% of the overall number of patients receiving SNM. This is probably true across the world. We wanted to see how well male patients do with SNM for various conditions such as overactive bladder, fecal incontinence, as well as chronic pelvic pain.

What were your notable findings? Were any of those surprising to you and your coauthors?

There are a few notable findings from this study. We examined 64 male patients who had received sacral neuromodulation over about a 7-year time frame. We looked at patient satisfaction, symptom improvement, complications, and the need for further treatments. The vast majority of patients who underwent neuromodulation—about 70%—were indicated for overactive bladder, a smaller proportion for fecal incontinence—around 16%—and about 11% for pelvic pain. We found that for overactive bladder and fecal incontinence, there were high satisfaction rates and high levels of efficacy at a year. That extended for several years. We're looking at probably 86% to 90% satisfaction rates and improvement rates.

What was notably different though, was the pelvic pain patients. They were generally less satisfied at a year—about 29%. The vast majority of people with pelvic pain required further types of treatments to help control their pain. The takeaway is that sacral neuromodulation works well for men with overactive bladder and fecal incontinence, but perhaps less well for pelvic pain. We should see it as one of many multimodal treatments that we could offer for men with chronic pelvic pain, which is an off-label indication for SNM.

What might further research on this topic include?

Further research for this could include some comparisons between male and female patients, further evaluation of male patients receiving sacral neuromodulation for the various indications, and perhaps we can see which phenotypes of men do better with neuromodulation, and which ones may ultimately need further types of treatments.

What is the take-home message for practicing urologists?

The overall take-home message from this study is that sacral neuromodulation is a viable and effective third-line treatment for men suffering with refractory overactive bladder and fecal incontinence. We have shown that it is an effective strategy for the treatment of these conditions in male patients, and it should absolutely be offered to men to treat their condition. Practitioners should not shy away from offering SNM, but in fact, it should be a good option that we can [use to] treat our male patients who suffer from these conditions.

Additionally, sacral neuromodulation as an off-label indication may help some men with chronic pelvic pain. However, it should be seen as one of many treatments that will be required to help alleviate some of those pain symptoms.

References

1. Alwashmi E, Otis-Chapados S, Elterman D. Sacral neuromodulation outcomes in male patients with pelvic pain and fecal incontinence. Presented at: 74th Annual Meeting of the Northeastern Section of the American Urological Association, Inc. October 27-29, 2022; Charlotte, North Carolina. Poster 46. Accessed October 27, 2022. https://nsaua.org/meetings/upcoming-meetings/schedule.aspx

2. Otis-Chapados S, Alwashmi E, Elterman D. Sacral neuromodulation outcomes in male patients with overactive bladder (neurogenic and non-neurogenic). Presented at: 74th Annual Meeting of the Northeastern Section of the American Urological Association, Inc. October 27-29, 2022; Charlotte, North Carolina. Poster 47. Accessed October 27, 2022. https://nsaua.org/meetings/upcoming-meetings/schedule.aspx