Factors Contributing to Sacral Neuromodulation Revision: A Single-Center Study

Sacral neuromodulation (SNM) is an effective therapy for non-neurogenic overactive bladder, non-obstructive urinary retention, and chronic fecal incontinence. Previous studies have shown SNM revision rates up to 39%, and the factors that predispose to revisions and complications remain incompletely understood. This study is aimed at characterizing reasons for SNM revision over an 18-month period to identify any potential predictors.

This is a retrospective chart review of patients following SNM implantation from 1 January 2021 to 17 May 2023 at a single academic center with five surgeons. Patient characteristics, procedural specifics, and reasons for revision were examined. Complications were defined as lead migration, infection, pain, or implantable pulse generator (IPG) issues.

A total of 127 patients were included for a total of 135 operations. The overall revision rate was 22% (30 out of 135) with a 6.7% explantation rate (9 out of 135). Primary reasons for revision included lead migration (7), infection (3), pain (3), no efficacy (8), IPG malpositioning (3), or desire for an MRI-compatible device (7). Of patients who underwent revisions, patients with complications had a lower BMI at the time of revision (p = 0.05) and were older (p = 0.007) than patients without complications. There were no differences between genders, or with use of an antimicrobial envelope.

The overall revision rates were lower than those in the published literature. Based on changes in BMI between implantation and subsequent revision, weight loss and older age were associated with more complications that necessitated revision. Use of an antimicrobial envelope did not change complication rates. Surgeons should decide whether its use is warranted given the added cost.