Objectives: To study the efficacy and safety of sacral neuromodulation (SNM) in women with dual urge incontinence (DUI).
Methods: Women with simultaneous urge urinary and urge fecal incontinence (FI) were prospectively identified and tested to determine eligibility for SNM. Those who experienced at least 50% improvement in their urinary symptoms were offered a full implant. Changes in FI were not considered. Validated questionnaires were administered at baseline and during follow-up. Preimplant urodynamic data were collected. Adverse events were recorded.
Results: A total of 11 women had DUI. All had greater than 50% improvement in their urinary symptoms and underwent full implantation. Average age was 76 years. Median follow-up was 14 months. There were statistically significant improvements in validated questionnaire scores. No women were able to achieve complete simultaneous urinary and fecal continence. Six women (54%) were able to achieve at least a 50% improvement simultaneously in both their urinary and fecal symptoms. Two women (18%) only experienced a significant improvement in their urinary symptoms. One (9%) only experienced significant improvement in her FI. Two (18%) experienced no significant improvement in either their urinary or fecal symptoms. The urodynamic findings did not correlate with outcome. Two patients had transient implant pain. One implant was removed due to lack of efficacy at patient's request.
Conclusions: SNM is a safe and effective treatment for DUI. In patients with DUI, complete continence rates may be lower than with either type of incontinence alone. DUI may be the end-organ manifestations of a common neurologic pathway-overactive stimulation or underactive inhibition.