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

Area of Science:

• Urology
• Neuromodulation
• Pelvic Floor Disorders

Background:

• Refractory overactive bladder, urinary retention, and fecal incontinence significantly impact quality of life.
• Sacral neuromodulation (SNM) is an established treatment for these conditions.
• Optimizing lead placement is crucial for successful SNM therapy.

Purpose of the Study:

• To identify factors associated with successful progression to stage 2 SNM.
• To evaluate the efficacy of an optimized lead placement technique using a curved stylet.
• To analyze patient characteristics influencing SNM treatment outcomes.

Main Methods:

• Retrospective analysis of a prospectively collected database of 127 patients undergoing stage 1 SNM.
• Patients received SNM for refractory overactive bladder, urinary retention, or fecal incontinence.
• Comparison of demographics and clinical/surgical factors between patients who advanced to stage 2 and those who did not.

Main Results:

• 89% of patients successfully progressed to stage 2 SNM.
• Low motor thresholds (≤2 mA) were achieved in 74% of patients.
• Urgency urinary incontinence was positively associated with stage 2 progression; male gender, pelvic pain history, and prior SNM were negatively associated.

Conclusions:

• The optimized lead placement technique is effective, achieving low motor thresholds and high stage 2 progression rates.
• Predictive factors for SNM success or failure can inform clinical decision-making.
• Understanding these factors aids in patient counseling and expectation management for SNM therapy.