Improving clinical outcomes for women with overactive bladder or urinary retention symptoms: a comparison of motor response voltages (1–9 V) during Stage 1 sacral neuromodulation

Abstract

Significant improvement was noted (up to 40%) in most clinical voiding parameters in the <3-V patients for both OAB and urinary retention. While <3 V will still statistically improve patient outcomes, a voltage <2 V may elicit self-reprogramming pain with severe bellows and plantar flexion movement, which may discourage patients from therapy adjustments. We recommend randomised, controlled trials to confirm these results.

Outcomes in a contemporary cohort undergoing sacral neuromodulation using optimized lead placement technique

“…However, this cohort preceded the curved stylet technique and reported higher mean voltages required for motor responses in patients with 1 to 2 (5.8 mA) or 3 (4.9 mA) active leads when compared to patients with four active leads (3.9 mA; P = 0.0001). Another study did demonstrate that any motor response ≤3 mA in any of the electrodes was associated in successful conversion of stage 1 to stage 2 SNM implantation . However, when our data was further stratified to this study's motor threshold cutoff of ≤3 mA in all or any single lead (97.6% of our patients met this criteria), there was no significant relationship with progression to stage 2 SNM.…”

Improving clinical outcomes with lower motor voltage (≤3 V) during stage 1 sacral neuromodulation for interstitial cystitis or bladder pain syndrome

“…We varied our approach amongst patients and selected 3 or 6 V during sacral neuromodulation, monitoring patient progress with objective voiding parameters of frequency, urgency, urgency incontinence, and nocturia, supplemented with additional quality of life measurements like IIQ‐7, UDI‐6, PGI‐I questionnaires. The results have been presented at numerous urological meetings (2015) and published in a urological journal (2018) . Further review sought to demonstrate, qualitatively and quantitatively, the long‐term importance of using ≤3 V (new experimental approach) during sacral neuromodulation, comparing two patient groups with either IC with Hunner's Ulcers or painful bladder syndrome.…”

“…Another third‐tier minimally invasive technique is posterior tibial neuromodulation, which provides minimal improvement in voiding and pain symptoms . The only surgical therapy with a consistent, clinically appreciable improvement is sacral neuromodulation for which midterm data (>5 year follow‐up) are few and generally evidence‐based level 2 or less . Although principles of classic electromyographic (EMG) theory suggest that eliciting motor response at a very low voltage (≤3 V) during sacral neuromodulation allows the practitioner to better approximate lead placement of the nerve to be modulated, Medtronic Inc (Minneapolis, MN) has encouraged an EMG motor response of ≥6 V to promptly elicit motor response and expedite implantation.…”

“…5 The only surgical therapy with a consistent, clinically appreciable improvement is sacral neuromodulation for which midterm data (>5 year follow-up) are few and generally evidence-based level 2 or less. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Although principles of classic electromyographic (EMG) theory suggest that eliciting motor response at a very low voltage (≤3 V) during sacral neuromodulation allows the practitioner to better approximate lead placement of the nerve to be modulated, Medtronic Inc (Minneapolis, MN) has encouraged an EMG motor response of ≥6 V to promptly elicit motor response and expedite implantation. We varied our approach amongst patients and selected 3 or 6 V during sacral neuromodulation, monitoring patient progress with objective voiding parameters of frequency, urgency, urgency incontinence, and nocturia, supplemented with additional quality of life measurements like IIQ-7, UDI-6, PGI-I questionnaires.…”

“…The results have been presented at numerous urological meetings (2015) and published in a urological journal (2018). 16 Further review sought to demonstrate, qualitatively and quantitatively, the long-term importance of using ≤3 V (new experimental approach) during sacral neuromodulation, comparing two patient groups with either IC with Hunner's Ulcers or painful bladder syndrome. Group A's motor response for Sacral #3 nerve bellows and plantar flexion was achieved at ≤3 V (new experimental approach), whereas group B had their motor response achieved at ≥4 V (traditional approach).…”