: Our cohort demonstrates that those patients who had an equivocal or failed outcome of office-based PNE were more likely to have a neurological insult. Patients with neurological insult who are considered appropriate candidates for neuromodulation trial should undergo staged implantation with quadruple tined lead in the operating room to provide these patients with the greatest opportunity for successful outcome.

Sacral neuromodulation (SNM) became a commercially approved therapy in the United States for treating functional disorders of the bladder in 1997 and fecal incontinence in 2011. Since that time, practitioners have had wide-ranging variations

Objective: The objective of this study was to investigate patient satisfaction and stress urinary incontinence (SUI) cure rates in females who underwent a midurethral I-Stop ® sling insertion. It is well established in current literature that midurethral sling insertion is a highly efficacious treatment for female SUI. The challenge with sling insertion is to find a product that addresses SUI caused by both urethral hypermobility and intrinsic sphincter deficiency (ISD). Thus, this study aims to highlight the success of an I-Stop ® midurethral slings for treatment of SUI in females with ISD and urethral hypermobility, while demonstrating low patient morbidity. Methods: Three hundred females who underwent midurethral I-Stop ® sling insertion from August 2011 through December 2019 were included in this retrospective chart review. Females with diagnosed SUI and ISD were included in this study. Females with ISD underwent retropubic sling insertion approach while all other patients diagnosed with SUI underwent a transobturator (TO) approach. Patients scheduled follow-up visits 2-, 6-, 12-, and 24-weeks post-procedure and then yearly thereafter. Statistical analysis was completed with a paired t-test. Results: This retrospective review yielded 300 females who underwent sling insertion with a mean age of 66.6 years and median follow up of 37 months. Satisfaction rate was rated 4 or 5 on a 5-point Likert scale by 91.7% of patients, and SUI correction rate was 95%. Highest satisfaction rates were reported by patients in the 65-75-year-old age group. No statistical significance was identified between any of the variables analyzed with the exception of reported SUI after sling insertion and satisfaction rate, p=0.048. Nine patients (3.0%) required sling lysis secondary to inability to void or difficulty voiding resulting in elevated post-void residual values >200cc. Ten patients had sling exposure requiring revision. No vaginal, urethral, or vesical perforations, and no persistent pain post-procedure was reported. Conclusion: Midurethral I-Stop ® sling insertion results in high patient satisfaction and SUI cure rates while maintaining low post-operative complications.