Surgical Procedures for NDO
Sacral neuromodulation. When sacral neuromodulation is considered, patients who respond to neuromodulation during the test phase proceed to full implantation of pulse generators and leads. Programming is required.37 Sacral neuromodulation is not approved for NDO. Patients with defined neurologic abnormalities such as multiple sclerosis or spinal cord injury may benefit from sacral neuromodulation, but studies in this population of patients have been few38,39 and sacral neuromodulation for NDO is an off-label use.
Augmentation cystoplasty. This reconstruction may be indicated for patients with refractory symptoms and those with risk or progression of upper tract deterioration. There is a high likelihood that lifelong intermittent catheterization will ultimately be required. Risks such as stones, metabolic and nutritional abnormalities, renal insufficiency, and malignancy are best treated through early recognition and prompt therapy.40,41
For OAB, clinicians should use a voiding diary and global response for QoL to determine effect of treatment as well as validated OAB-specific questionnaires, and should query patients about AEs.
Although global response scales for QoL and a voiding diary to determine effect of treatment for NDO are important, the clinician also may need to know urodynamic testing outcomes, especially in patients with elevated detrusor pressures, to assess that there is no risk of future upper tract damage.
“Treatment success” is complex and based on individual patient expectations. Communicating with and explaining all appropriate options to the patient, based on the differing efficacy and AE profiles of the treatments available for OAB and NDO as well as eliciting patient input, can enhance outcomes.
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