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Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice
Thomas C Dudding1, Paul A Lehur2, Michael Sørensen3
1Pelvic Floor Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Summary
Troubleshooting sacral neuromodulation (SNM) involves reprogramming the device to address symptom persistence or side effects. This guide offers practical solutions for sub-optimal outcomes, improving patient satisfaction with SNM therapy.
Area of Science:
- Urology
- Neurology
- Medical Devices
Background:
- Sacral neuromodulation (SNM) is used for urinary and fecal incontinence.
- Some patients experience persistent symptoms, reduced efficacy, or adverse effects.
- Hardware failure can also occur with SNM devices.
Purpose of the Study:
- To provide practical guidance for troubleshooting sub-optimal outcomes in SNM therapy.
- To offer solutions for issues like reduced efficacy and adverse stimulation effects.
- To address hardware failure scenarios in SNM.
Main Methods:
- A systematic literature review was conducted.
- Expert multidisciplinary group clinical experience was utilized.
- Guidance was developed by a group of European experts.
Main Results:
- Reprogramming strategies include adjusting electrode configuration, stimulation amplitude, pulse frequency, and pulse width.
- Guidance is provided for managing loss of efficacy and adverse stimulation effects.
- Management strategies for various hardware failure scenarios are described.
Conclusions:
- Reprogramming aims to improve patient symptoms and ensure comfortable therapy delivery.
- Initial reprogramming steps can be performed at home, reducing hospital visits.
- A logical, stepwise approach to reprogramming enhances outcomes and patient satisfaction.
