Short- and mid-term efficacy of sacral neuromodulation in the treatment of neurogenic overactive bladder in patients with multiple sclerosis

Background: Sacral neuromodulation (SNM) is commonly used in the treatment of overactive bladder, but few studies have evaluated its efficacy in patients with multiple sclerosis (MS). Objectives: To assess the efficacy of SNM in the treatment of neurogenic overactive bladder (nOAB) in patients with MS. Methods: All MS patients that underwent a two-stage SNM to treat nOAB between 2013 and 2023 in four university hospitals were considered eligible. The primary outcome was clinical efficacy, defined as the implantation of an implantable pulse generator (IPG). Secondary outcome included the Patient Global Impression of Improvement (PGI-I), the 3-day bladder diary parameters and the maintenance of efficacy within 5 years. Results: A total of 38 patients were included. The IPG was implanted in 33 patients (87%). The median daily (9.0 to 7.0; p < 0.001) and nocturnal (2.5 to 1.0; p < 0.01) number of micturition/clean self-intermittent catheterization (CISC), the presence of urinary urgency (97% vs 58%; p < 0.01) and urinary incontinence (84% vs 25%, p < 0.001) significantly decreased at the end of the test phase. Efficacy was maintained at 5 years in 46% of cases. Conclusions: In MS patients with nOAB, SNM exhibits clinical efficacy comparable to that observed in the non-neurological population.