Do you really want to deactivate your sacral neuromodulation device during pregnancy? A single center case series

Abstract

Introduction and hypothesis The main objective of the study is to assess the efficacy and safety of sacral neuromodulation (SNM) during pregnancy. Methods We retrospectively enrolled patients who underwent SNM implantation in our center and subsequently became pregnant. The indication for SNM, timing of device de-activation (if performed), course of pregnancy and urological complications, duration of labor, childbirth term, delivery mode, congenital abnormalities and SNM dysfunctions after delivery were recorded. Results Fourteen pregnancies were recorded among 11 women undergoing SNM. Indications for device implantation were urinary retention (7 cases) and dysfunctional voiding (4 cases). Two patients carried on two and three pregnancies, respectively, with the device turned off since the first trimester. They both had to return to self-catheterization and developed recurring urinary tract infections. No major urological complications were recorded among the remaining nine women that kept the device on during pregnancy. A cesarean section was performed in four cases for obstetric reasons, and in seven cases it was planned by the urologist and gynecologist to avoid lead damage/displacement. Three pregnancies resulted in a vaginal delivery, and no association with term of delivery or duration of labor was observed. No congenital abnormalities related to SNM or lead displacement are reported, and only one patient required device removal because of significant loss of efficacy after childbirth. Conclusions The use of SNM during pregnancy appears to be safe, without morbidity for the fetus. Moreover, risks associated with switching the device off may be greater than benefits and justify maintaining the electrical stimulation throughout pregnancy.

Maternal and foetal physiological response of sacral surface electrical stimulation during pregnancy: A preliminary study

“…Electrical stimulation of the bilateral S1 dorsal roots in rats, where the parasympathetic nerves are located, showed no adverse effects on pregnant rats and foetuses (Wang & Hassouna, 1999). Two reviews (Mahran et al, 2017;Yaiesh et al, 2016) and one case series (Agnello et al, 2021) reported the use of sacral neuromodulation in pregnant patients with bladder dysfunction or faecal incontinence (Agnello et al, 2021;Mahran et al, 2017;Wang & Hassouna, 1999;Yaiesh et al, 2016) are consistent with the current study.…”

“…Some women have undergone electrical stimulation therapy even during pregnancy for these disorders. Sacral neuromodulation implantation was shown to be effective for pregnant patients with bladder dysfunction or faecal incontinence and caused no maternal or foetal adverse effects (Agnello et al., 2021; Mahran et al., 2017; Yaiesh et al., 2016); however, electrical stimulation using sacral neuromodulation implantation is invasive. Sacral surface electrical stimulation (ss‐ES) of the skin over the posterior sacral foramen is a non‐invasive method for neuromodulation of the S2–S4 area and has produced similar effects (Yokozuka et al., 2004).…”

Sacral Neuromodulation in Pregnant Women—A Case Report and Literature Review

“…After excluding duplicates, articles only available as abstracts, articles in languages other than English, and articles not related to sacral neuromodulation therapy, only 11 papers remained. Three original animal studies [ 10 , 11 , 12 ], six case reports [ 13 , 14 , 15 , 16 , 17 , 18 ], one systematic review, and one literature review [ 19 , 20 ] were analysed. The case reports included 1 to 14 pregnancies in women treated with SNM.…”

“…Of patients who gave birth prematurely, 1 maintained neuromodulation and 8 turned off the IPG. The causes of preterm labour were various: premature uterine contraction, premature detachment of the placenta, recurrent UTIs, chronic symphysis pubis dysfunction, and the need for chemotherapy for breast cancer [ 13 , 16 ].…”

“…Sacral neuromodulation was active throughout the pregnancy and postpartum, and no issues were raised regarding the malfunction or displacement of the device. Subsequently, Agnello and colleagues [ 16 ] reported a case series of 14 pregnancies among 11 women with urinary retention and dysfunctional voiding treated with SNM. Two patients deactivated the devices from the first trimester and ended up having to return to self-catheterisation and experiencing recurrent UTIs.…”