A modified approach to patient's selection with improved clinical outcomes in sacral nerve modulation

Area of Science:

• Urology
• Neurology
• Neurosurgery

Background:

• Percutaneous permanent tined leads (PPTL) are increasingly used, sometimes replacing percutaneous nerve evaluation (PNE) for screening.
• This study evaluates PNE as a screening tool for sacral nerve stimulation in refractory voiding dysfunction.
• A strict success criterion (>60% improvement) was employed due to limited hospital resources.

Purpose of the Study:

• To assess the utility of PNE as a screening tool for sacral nerve stimulation.
• To evaluate the use of PPTL as an adjunct to PNE to enhance screening outcomes.
• To analyze the effectiveness and success rates of PNE and subsequent sacral nerve stimulation procedures.

Main Methods:

• A retrospective chart review of 106 patients who underwent PNE between 2001 and 2008.
• Analysis of procedure outcomes, complication rates, and long-term effects.
• Comparison of outcomes between PNE-selected patients and those undergoing simultaneous PPTL and implantable pulse generator (IPG) implantation.

Main Results:

• 116 PNE procedures were performed, with an overall success rate of 54%.
• Of 62 successful PNE patients, 45 proceeded to stage I implantation, achieving a 93% success rate.
• 12 patients underwent simultaneous PPTL and IPG implantation, with 10 successful outcomes.

Conclusions:

• Percutaneous nerve evaluation (PNE) serves as a valuable adjunct in the staged procedure for selecting appropriate sacral nerve stimulation candidates.
• The PNE method, particularly with a stringent success definition, is effective in resource-limited environments.
• Sacral nerve stimulation, when guided by PNE, offers a viable treatment option for refractory voiding dysfunction.