Rate of IPG Placement for Sacral Neuromodulation in Patients With CNS Pathology

Little is known about the efficacy of sacral neuromodulation in patients with central nervous system (CNS) pathology.

The objective of this study was to assess the rate of internal pulse generator (IPG) implantation for sacral neuromodulation (SNM) in patients with CNS pathology with overactive bladder (OAB) or urinary retention in women.

This was a retrospective study utilizing the TriNetX Research Network platform, using the years 2010 to 2025, collected on March 27, 2025. Two separate queries of the data set were performed to obtain our cohorts due to the differences in inclusion criteria and endpoints. For our OAB cohorts, adult (18 years or older) female participants were included in the study if they had OAB, urge incontinence, or urgency of urination via International Classification of Diseases (ICD) codes. We then developed 6 cohorts for (1) dementia, (2) Parkinson disease, (3) stroke, (4) multiple sclerosis (MS), (5) normal pressure hydrocephalus (NPH), and (6) an aggregate cohort. We utilized ICD codes and medication codes for the aforementioned diagnoses. Each cohort had either stage 1 SNM placement or peripheral nerve evaluation (PNE) via Current Procedural Terminology (CPT) codes after 2010. Control participants included all female adult participants without any of the aforementioned neurological diagnoses. The primary outcome was the rate of neurostimulator device IPG placement within 1 month of stage 1 or PNE. A second group of cohorts was developed for urinary retention. Adult female participants were included in the study if they had retention of urine. We developed 4 cohorts: (1) dementia, (2) Parkinson disease, (3) stroke, and (4) MS, utilizing the previous ICD codes and medications. Each cohort had either stage 1 SNM placement or PNE placed after 2010. The primary outcome was the rate of neurostimulator device IPG placement (CPT code 64590) within 3 months of stage 1 or PNE.

Compared with the control (4,337 of 7,805, 55.56%), there was a statistically significant reduction in the rates of SNM IPG implantation in patients with dementia (179 of 375, 47.73%) and the aggregate (483 of 984, 49.09%). There was no significant difference in SNM IPG implantation for the Parkinson disease, stroke, MS, and NPH cohorts. In the urinary retention group, compared with the control population, there were no statistically significant differences in the rate of SNM IPG implantation in the cohorts.

Our study suggests that SNM has equal efficacy in patients with CNS pathology with OAB or urinary retention, similar to the nonneurogenic population, except in patients with dementia, who have lower rates of IPG implantation for OAB.