Effect of Sacral Neuromodulation Rate on Overactive Bladder Symptoms: A Randomized Crossover Feasibility Study

Area of Science:

• Urology
• Neuroscience
• Biomedical Engineering

Background:

• Overactive bladder (OAB) significantly impacts quality of life.
• Sacral neuromodulation (SNM) is a treatment for OAB.
• Optimizing SNM parameters, like stimulation rate, is crucial for effective treatment.

Purpose of the Study:

• To assess the impact of different sacral neuromodulation (SNM) stimulation rates on overactive bladder (OAB) symptoms.
• To evaluate the variability in OAB symptoms and adverse events across three SNM rate settings.
• To determine the optimal rate setting for SNM in managing urgency incontinence.

Main Methods:

• A single-center, IRB-approved study utilized a 3x3 orthogonal Latin squares crossover design.
• Thirteen female subjects with urgency frequency and urinary urge incontinence were enrolled.
• Subjects were exposed to three SNM rate settings (5.2, 14, and 25 Hz) for one week each, in randomized sequences.

Main Results:

• The stimulation rate significantly affected the number of daily incontinence episodes (P < 0.001) and pad changes (P = 0.039).
• The 5.2 Hz rate setting resulted in more incontinence episodes and pad changes compared to 14 Hz and 25 Hz.
• Nine subjects reported 21 adverse events, with the lowest number of programming-related events observed at 14 Hz.

Conclusions:

• Sacral neuromodulation (SNM) rate significantly influences the efficacy of treating overactive bladder (OAB) symptoms.
• The 14 Hz and 25 Hz settings demonstrated comparable efficacy in reducing incontinence episodes and pad changes.
• The 14 Hz rate setting appeared to offer the best balance between symptom control and safety, with the lowest incidence of adverse events.