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Long-Term Outcomes of Sacral Neuromodulation Explantation: A 12-Year Experience at a High-Volume Tertiary Center
Carly Fiorido1, Mario Henrique Bitar Siqueira2, Mohammed Aldoukhi2
1University Health Network, Toronto, Ontario, Canada.
Introduction:
Sacral neuromodulation (SNM) is a therapeutic option offered to patients with idiopathic overactive bladder (OAB) or non-obstructive urinary retention, as an alternative treatment for refractory medical management. It allows for electrical stimulation of inhibitory circuits that modulate the micturition reflex and improve lower urinary tract symptoms. Despite high efficacy and safety, explantation remains a challenge clinically as it is unknown which factors predict explantation. Herein, we sought to understand the factors influencing SNM explantation.
Methods:
We conducted a long-term retrospective cohort study of 587 patients receiving SNM at one academic tertiary care center in Toronto, Ontario, performed by one surgeon.
Results:
The Kaplan-Meier analysis demonstrated explantation-free survival probabilities of 97% (95% CI 96%-99%) at 1 year, 92% (90%-95%) at 3 years, and 81% (77%-86%) at 5 years. We did not determine any variables independently associated with time nor risk of explantation. The most common indication for explantation was loss of efficacy (57.7%), followed by patient preference (16.7%) and pain (16.7%).
Conclusion:
Explantation after SNM occurs in a minority of patients, and is largely attributable to a loss of sustained therapeutic efficacy over time.