TY - JOUR
T1 - Outcomes in a contemporary cohort undergoing sacral neuromodulation using optimized lead placement technique
AU - Adelstein, Sarah A.
AU - Lee, Wai
AU - Gioia, Kevin
AU - Moskowitz, Dena
AU - Stamnes, Kelsey
AU - Lucioni, Alvaro
AU - Kobashi, Kathleen C.
AU - Lee, Una J.
N1 - Funding Information:
The authors would like to acknowledge Steven Siegel, MD for his teaching of the optimal Interstim lead placement technique when he visited our facility in August 2014 and shared his expertize. The authors appreciate assistance from Sharon Durfy, PhD with manuscript preparation and Sydney Akapame, PhD with statistical analyses. The study was funded by Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Neuromodulation grant, 2015.
Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2019/8
Y1 - 2019/8
N2 - Aims: To evaluate factors associated with progression to stage 2 sacral neuromodulation (SNM) for refractory overactive bladder, urinary retention, or fecal incontinence using optimal lead placement techniques with curved stylet. Methods: This is a retrospective analysis of a prospectively collected database of all consecutive stage 1 SNM lead placements at our institution between August 2014 and May 2017 using optimal lead placement technique with curved stylet. Patients with refractory overactive bladder, urinary retention, or fecal incontinence were enrolled. Patients with 50% or more symptom improvement on voiding diaries were offered stage 2 implant. Demographics, clinical, and surgical characteristics were compared for patients who underwent successful stage 2 implants versus those who underwent lead removal at the end of the stage 1 trial period. Results: 127 patients underwent SNM during the study period. Motor thresholds of ≤2 mA in all four electrodes were achieved in 74% of patients (94/127). A total of 89.0% (113/127) of patients received stage 2 implants. The main indication for implant, specifically urgency urinary incontinence, was positively associated with progression to stage 2 implant. Male gender, history of pelvic pain and previous SNM were negatively associated with progression to stage 2 implant. Conclusions: Our findings demonstrate that the contemporary optimized lead placement technique resulted in low motor thresholds and successful progression to stage 2 SNM implant in the majority of our cohort. Predictive factors associated with success or failure may potentially guide decision making for therapeutic interventions and counseling patient expectations.
AB - Aims: To evaluate factors associated with progression to stage 2 sacral neuromodulation (SNM) for refractory overactive bladder, urinary retention, or fecal incontinence using optimal lead placement techniques with curved stylet. Methods: This is a retrospective analysis of a prospectively collected database of all consecutive stage 1 SNM lead placements at our institution between August 2014 and May 2017 using optimal lead placement technique with curved stylet. Patients with refractory overactive bladder, urinary retention, or fecal incontinence were enrolled. Patients with 50% or more symptom improvement on voiding diaries were offered stage 2 implant. Demographics, clinical, and surgical characteristics were compared for patients who underwent successful stage 2 implants versus those who underwent lead removal at the end of the stage 1 trial period. Results: 127 patients underwent SNM during the study period. Motor thresholds of ≤2 mA in all four electrodes were achieved in 74% of patients (94/127). A total of 89.0% (113/127) of patients received stage 2 implants. The main indication for implant, specifically urgency urinary incontinence, was positively associated with progression to stage 2 implant. Male gender, history of pelvic pain and previous SNM were negatively associated with progression to stage 2 implant. Conclusions: Our findings demonstrate that the contemporary optimized lead placement technique resulted in low motor thresholds and successful progression to stage 2 SNM implant in the majority of our cohort. Predictive factors associated with success or failure may potentially guide decision making for therapeutic interventions and counseling patient expectations.
KW - implanted neurostimulators
KW - overactive bladder
KW - sacral neuromodulation
KW - urinary incontinence
KW - urinary retention
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U2 - 10.1002/nau.24018
DO - 10.1002/nau.24018
M3 - Article
C2 - 31044466
AN - SCOPUS:85065257749
VL - 38
SP - 1595
EP - 1601
JO - Neurourology and Urodynamics
JF - Neurourology and Urodynamics
SN - 0733-2467
IS - 6
ER -