The impact of sacral neuromodulation on male erectile function
Simoes de Oliveira, P1; Riberio de Oliveira, T1; Martinho, D1; Pereira e Silva, R1; Marcelino, J1; Palma Reis, J1; Martins, F1; Lopes, T1
1: Hospital de Santa Maria, Portugal
Objective: To evaluate the impact of sacral neuromodulation (SNM) on male erectile function.
Materials & methods: We retrospectively analyzed all male patients who underwent SNM therapy, from May 2012 to August 2016. Erectile function was assessed in all sexually active individuals, before surgery and postoperatively with the International Index of Erectile Function (IIEF-5).
Results: Of the 18 patients who underwent stage-1 SNM, 10 were permanently implanted. One patient had no active sexual life and was excluded. Median age was 42 years (27-65). Five patients (55.5%) had non-obstructive chronic urinary retention (CUR), one patient (11.1%) refractory overactive bladder (OAB), two patients (22.2%) detrusor overactivity with impaired contractility (DOIC) and, one patient (11.1%) fecal incontinence (FI). Median IIEF-5 score before SNM was 10 (Q1=8.5; Q3=22.5), median IIEF-5 after SNM was 17 (Q1=11; Q3=22.5), with 4 patients (44.4%) presenting IIEF-5 improvement after SNM. Patients <40 yr. presented 66.7% of improvement, patients >40 yr., 33.3%. Patients with CUR presented 20% of improvement, OAB, 100%, DOIC, 100% and, FI no improvement (0%). Patients with a PVR (post-void residual urine) before SNM <150 mL presented 66.7% of improvement and PVR >150 mL, 33.3%.
Conclusion: Although erectile dysfunction is not currently an indication for SNM, several patients in our series presented some degree of improvement after sacral neurostimulator implantation. The predictive factors for improvement are unknown but possibly parasympathetic nerves stimulation at S2-S4 roots plays a role in the response mechanism and should be the aim of further prospective studies.
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