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Motor Response Matters: Optimizing Lead Placement Improves Sacral Neuromodulation Outcomes.

Javier Pizarro-Berdichevsky1, Bradley C Gill2, Marisa Clifton3

  • 1Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Urogynecology Unit, Sotero del Rio Hospital and Division Obstetricia y Ginecologia, Pontificia Universidad Catolica de Chile, Santiago, Chile.

The Journal of Urology
|November 21, 2017
PubMed
Summary

Greater motor response during sacral neuromodulation lead placement, particularly toe responses, correlates with more durable therapy. Fewer responses indicate a higher likelihood of lead revision, suggesting improved outcomes with more robust intraoperative testing.

Keywords:
implantable neurostimulatorsmotor activityoveractivereoperationtoesurinary bladder

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Area of Science:

  • Urology
  • Neurosurgery
  • Medical Devices

Background:

  • Sacral neuromodulation (SNM) is a treatment for lower urinary tract dysfunction.
  • Optimizing lead placement is crucial for long-term SNM efficacy.
  • Intraoperative motor responses during lead placement are used as a guide.

Purpose of the Study:

  • To evaluate the association between motor responses during SNM lead placement and the durability of therapy.
  • To test the hypothesis that more motor responses predict longer-lasting SNM treatment.

Main Methods:

  • Retrospective review of 176 SNM lead placements (2010-2015).
  • Quantification of motor responses (bellows and toe subscores, total score 0-8).
  • Analysis of lead revision rates as the primary outcome using univariate and multivariate logistic regression.

Main Results:

  • 19% of patients required lead revision.
  • Lower total electrode response scores (p=0.027) and toe subscores (p=0.033) were associated with revision.
  • Age < 59 (OR 5.5) and total response score < 4 (OR 4.2) predicted revision.

Conclusions:

  • Fewer total and toe motor responses during SNM lead placement are linked to higher rates of lead revision.
  • Optimizing lead placement to achieve more toe responses may enhance the durability of SNM therapy.