Cognitive impairment does not impact sacral neuromodulation implant rates for overactive bladder

Area of Science:

• Urology
• Geriatrics
• Neurology

Background:

• Overactive bladder (OAB) significantly impacts quality of life in older adults.
• Sacral neuromodulation (SNM) is an effective treatment for refractory OAB.
• The influence of cognitive impairment (CI) on SNM outcomes in elderly patients remains unclear.

Purpose of the Study:

• To investigate the effect of pre-existing or newly diagnosed cognitive impairment (CI) on the success of sacral neuromodulation (SNM) in patients aged 55 and older with overactive bladder (OAB).

Main Methods:

• Retrospective review of patients (≥55 years) undergoing test-phase SNM for OAB from 2014-2021.
• Data collected included demographics, comorbidities, CI diagnoses (dementia or mild CI), and SNM procedure details.
• Logistic regression analysis evaluated the impact of CI on SNM implantation rates.

Main Results:

• Of 510 patients, 10.1% had CI at SNM and 5.8% were diagnosed post-SNM. Patients with CI were older and had more comorbidities.
• Univariable analysis showed no significant difference in implantation rates between patients with and without CI (85.4% vs. 76.9%, p=0.16).
• Multivariable analysis identified peripheral nerve evaluation (PNE), age, and prior beta-3 agonist use as negative predictors of implantation, but not CI or dementia. Explant and revision rates were similar regardless of CI status.

Conclusions:

• Patients with OAB and cognitive impairment (CI) diagnoses achieve sacral neuromodulation (SNM) implant success rates comparable to those without CI.
• A diagnosis of CI should not be a contraindication for considering SNM therapy in patients with refractory OAB.