Cognitive impairment does not impact sacral neuromodulation implant rates for overactive bladder

Abstract

Objective To evaluate the impact of cognitive impairment (CI) diagnoses on sacral neuromodulation (SNM) outcomes in older patients. Materials and Methods We completed a retrospective review of all patients aged ≥55 years who underwent test‐phase SNM (peripheral nerve evaluation (PNE) or stage 1) for overactive bladder (OAB) between 2014 and 2021 within a large multi‐regional health system. Patient demographics, relevant comorbidities, CI diagnoses (dementia or mild CI), and SNM procedures were recorded. Logistic regression modeling was performed to evaluate the impact of CI on SNM implantation rates. Results Five‐hundred and ten patients underwent SNM test phase (161 PNE, 349 Stage 1) during the study period. The mean age was 71.0(8.5) years, and most (80.6%) were female. Overall, 52(10.1%) patients had a CI diagnosis at the time of SNM, and 30 (5.8%) were diagnosed at a median of 18.5 [9.25, 39.5] months after SNM. Patients with CI diagnoses were older, with more comorbidities, and were more likely to undergo PNE. Univariable comparison found no difference in implantation rate based on pre‐SNM CI (85.4% vs. 76.9%, p = 0.16). Multivariable analysis identified PNE (OR 0.43, 95% CI 0.26–0.71), age (OR 0.96, 95%CI 0.93‐0.98), and prior beta‐3 agonist use (OR 0.60, 95% CI 0.37‐0.99) but not CI or dementia as independent negative predictors of implantation. Implanted patients had a median follow‐up of 25 [12.0, 55.0] months. Explant and revision rates did not differ according to CI. Conclusion Patients with OAB and CI diagnoses proceed to SNM implant at rates similar to patients without CI diagnoses. A diagnosis of CI should not necessarily exclude patients from SNM therapy for refractory OAB.

The impact of cognitive impairment in urologic implants: a narrative review

“…Zillioux et al , in a retrospective analysis of patients who underwent SNM for OAB found 10.2% (52/510) had cognitive impairment diagnosis in their chart at time of test-phase implant, with an additional 6% (30/510) receiving a diagnosis following test-phase SNM ( 65 ). Based on the retrospective methods which relied on electronic medical record diagnosis codes, the authors noted that these estimates were likely an underestimate.…”

Mixed Urinary Incontinence: Diagnosis and Management

“…While impaired cognition could certainly affect a patient's ability to make adjustments in therapy after permanent implantation, which may limit the efficacy of the device, more importantly it could affect the ability of the provider to assess the efficacy during trial phase if the patient is unable to clearly articulate improvements. However, a recent retrospective review on the use of SNM in people over 55 years old found that a pre-existing diagnosis of cognitive impairment was not a predictor in going on to final implantation of the device, suggesting cognitive impairment should not exclude the use of this therapy in older patients [92]. Finally, implantation of the device is also more invasive than other third-line OAB treatments, and the risk of undergoing even this minor surgical procedure in a frail patient should be considered carefully.…”