Does choice of anesthesia during stage 1 sacral neuromodulation testing influence outcomes?

Area of Science:

• Urology
• Neuromodulation
• Anesthesiology

Background:

• Staged sacral neuromodulation (SNM) is effective for voiding dysfunction.
• Stage 1 SNM (SNM-I) lead placement can use monitored anesthesia care (MAC) or general anesthesia (GA).
• MAC allows sensory and motor assessment, while GA permits only motor assessment, potentially impacting lead placement.

Purpose of the Study:

• To evaluate if anesthesia type influences the progression rate to permanent sacral neuromodulation implantation (SNM-II).

Main Methods:

• Retrospective chart review of 121 patients undergoing SNM-I for overactive bladder (2005-2023).
• Patients were grouped by anesthesia: MAC (n=95) or GA (n=26).
• Progression to SNM-II was defined as ≥50% symptom improvement during a 1-2 week trial.

Main Results:

• No significant difference in progression to SNM-II between MAC (72%) and GA (73%) groups (p=0.39).
• Comparison with recent MAC patients also showed no difference (MAC 77% vs. GA 73%; p=0.48).

Conclusions:

• Anesthesia type for SNM-I does not affect the rate of progression to SNM-II.
• Results support using motor responses alone for lead placement during SNM-I, even under GA.