Early Sacral Neuromodulation: A Promising Opportunity or an Overload for Patients with a Recent Spinal Cord Injury? A Cross-Sectional Study

TL;DR

This study explores whether patients with spinal cord injuries would agree to early sacral neuromodulation to improve urinary tract dysfunction, finding that a majority would consent if informed properly.

Contribution

The study provides novel insights into patient attitudes toward early sacral neuromodulation following spinal cord injury, highlighting potential for early intervention acceptance.

Findings

61.9% of patients would have agreed to early treatment before autonomic dysfunction emerged.

51.8% of patients would have consented to early sacral neuromodulation.

Many patients underestimated the severity of neurogenic lower urinary tract dysfunction, correlating with lower quality of life.

Abstract

Background: A solid rationale exists for early sacral neuromodulation in the form of causal therapy that improves neurogenic lower urinary tract dysfunction after complete spinal cord injury. However, the short and early time frame for minimally invasive therapy poses a series of ethical and medical issues, which has impeded clinical realisation thus far. Objectives: We performed a cross-sectional study on patients with chronic spinal cord injury to learn about patients’ attitudes towards early treatment to prepare for large randomised controlled trials. Methods: A cohort of patients (n = 86, mixed genders) with spinal cord injury over two years was analysed. Their lower urinary tract-related quality of life was assessed using the Qualiveen-30 tool. The extent of neurogenic lower urinary tract dysfunction, patients’ awareness of it, and their attitude towards early sacral neuromodulation were explored with a specific questionnaire. Results: A total of 61.9% (n = 52) of patients declared that, in retrospect, they would have agreed to early treatment prior to the emergence of their autonomic dysfunction. Of these patients, 51.8% (n = 29) would have also consented to early sacral neuromodulation. Quality of life had no impact on their decision. More than half of the patients (n = 49, 57.0%) stated they had not grasped the momentous nature of neurogenic lower urinary tract dysfunction when being informed about it. This finding was subsequently correlated with a decreased lower urinary tract-related quality of life. Conclusion: Patients with neurogenic lower urinary tract dysfunction are likely to agree to an early therapeutic approach. Clinical implementation requires knowledge and acceptance of the procedure on the part of patients and their caregivers.

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