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Beitragstitel Sacral nerve modulation for LUTS in patients with Joint Hypermobility Syndrome
Beitragscode P101
Autor:innen
  1. Vanessa Fenner Dre Fenner Urologie Sarl Präsentierende:r
  2. Jalesh Panicker UCLH NHS Foundation Trust
  3. Rizwan Hamid UCLH NHS Foundation Trust
  4. Jeremy Ockrim UCLH NHS Foundation Trust
  5. Tamsin Greenwell UCLH NHS Foundation Trust
  6. Mahreen Pakzad UCLH NHS Foundation Trust
Präsentationsform unmoderierte Poster
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Abstract-Text Joint hypermobility syndrome (JHS) is a heritable connective tissue disorder characterized by tissue fragility and multisystem manifestations. As a consequence of their altered collagen structure, patients with JHS may be more prone to surgical complications, such as wound infection. The aim of this study was to evaluate treatment outcomes and morbidity, in patients with JHS following treatment with sacral nerve modulation (SNM) for lower urinary tract symptoms (LUTS).

Outcomes following SNM implant for LUTS between 2013- 2018 in patients with JHS in our single centre tertiary referral unit, were retrospectively analysed. Collected data included patient demographics, validated quality of life and symptom questionnaires (SF-Qualiveen, ICIQ-OAB, ICIQ-LUTS, LARS, EQ-5D-5L), cystometrogram results, uroflowmetry, post void residuals (PVR), 3-day bladder diary, as well as complications and re-operations.

Eighteen women with JHS and LUTS who underwent a two-stage Interstim II Medtronic SNM were identified (mean age 29 years-old (range 17-48)). Ten patients (56 %) were diagnosed with high tone non-relaxing sphincter (HTNRS), 3 (17 %) had detrusor overactivity (DO), 2 (11 %) had acontractile bladder, 2 (11 %) had combined HTNRS and DO, and 1 (5 %) was diagnosed with combined HTNRS and hypocontractile bladder. Following the first stage SNM tined lead trial, 33 % (n=6) patients had a removal of the tined lead for complications or failure. Of the 12 patients who underwent the second stage SNM, 6 (50 %) suffered from complications resulting in re-operation with either re-siting of tined lead (n=1), re-siting of battery (n=2) or entire device removal (n=3). Finally, of the 9 patients who had their device removed after first or second stage SNM, 5 had a new first stage SNM with only 2 (40 %) resulting in a successful final SNM implant.

SNM is a valid therapeutic option for LUTS in patients with JHS, demonstrated by the fact that 61% (n=11/18) of the JHS patients currently have a functioning SNM in situ, which is effectively treating their LUTS. However, this retrospective analysis indicates that 50 % (n=9) suffered from SNM-related complications. This figure is significantly higher than the complication rate in the general LUTS population treated with SNM. We suggest that SNM is offered to JHS patients only after careful counselling, making them fully aware of the significantly higher risks of treatment failure, re-operation, pain and wound infection.