Outcomes in a contemporary cohort undergoing sacral neuromodulation using optimized lead placement technique

Sarah A. Adelstein, Wai Lee, Kevin Gioia, Dena Moskowitz, Kelsey Stamnes, Alvaro Lucioni, Kathleen C. Kobashi, Una J. Lee

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1595-1601
Number of pages7
JournalNeurourology and Urodynamics
Volume38
Issue number6
DOIs
StatePublished - Aug 2019

Keywords

  • implanted neurostimulators
  • overactive bladder
  • sacral neuromodulation
  • urinary incontinence
  • urinary retention

ASJC Scopus subject areas

  • Clinical Neurology
  • Urology

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