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

Area of Science:

• Urology
• Neuromodulation
• Surgical Outcomes

Background:

• Sacral neuromodulation (SNM) effectively treats overactive bladder, urinary retention, and fecal incontinence.
• High SNM revision rates (up to 39%) necessitate understanding predictors for complications.
• Factors influencing SNM revisions and complications remain incompletely understood.

Purpose of the Study:

• To characterize reasons for SNM revision over an 18-month period.
• To identify potential predictors of SNM revision and associated complications.
• To evaluate the effectiveness of antimicrobial envelopes in reducing SNM complications.

Main Methods:

• Retrospective chart review of 127 patients undergoing SNM implantation.
• Analysis of patient characteristics, procedural details, and reasons for revision.
• Complications defined as lead migration, infection, pain, or implantable pulse generator (IPG) issues.

Main Results:

• The overall SNM revision rate was 22% (30/135), with a 6.7% explantation rate (9/135).
• Primary revision reasons included lead migration (7), no efficacy (8), and desire for MRI-compatible device (7).
• Complications were associated with lower BMI (p=0.05) and older age (p=0.007) at revision.

Conclusions:

• SNM revision rates were lower than previously published literature.
• Weight loss and older age correlated with increased complications requiring revision.
• Antimicrobial envelopes did not impact complication rates; their use warrants cost-benefit consideration.