International continence society best practice statement for use of sacral neuromodulation

Abstract

ResultsThe present recommendations, based on the most relevant data available in the literature, as well as expert opinion, address a variety of specific and at times problematic issues associated with SNM. These include the use of SNM for a variety of underlying conditions, need for pre-procedural testing, use of staged vs single-stage procedures, screening for success during the trial phase, ideal anesthesia, device implantation, post-procedural management, trouble-shooting loss of device function, and future directions for research. Conclusions:These guidelines undoubtedly constitute a reference document, which will help urologists, gynecologists, and colorectal surgeons optimize their use of SNM for refractory urinary urgency and frequency, UUI, NOR, and FI.• Eight urologists, three colorectal surgeons and two urogynecologists, covering a wide breadth of geographic and specialty interest representation, met for two days in Chicago, Illinois, USA on January 19-20, 2017 to discuss best practices for neuromodulation. Suggestions for statements were submitted in advance and specific topics were assigned to committee members. Committee members prepared each assigned topic and presented supporting data to the group at which time each topic was discussed in depth. Best practice statements were formulated based on available data and expert opinion and then each member prepared a discussion section for each particular topic which reflected the current literature and expert opinion. Another urologist was added to the group during the initial writing process. After multiple rounds of editing within the group the highlights of the statements were presented at the ICS meeting in Florence, Italy in September 2017. This document was then circulated to multiple external reviewers after which final edits were made and approved by the group.• The meeting and editing expenses were supported by the ICS. Funding to support this project was based on an unrestricted society-initiated grant made by Medtronic to the ICS.• As many of the recommendations herein are based on expert panel consensus, the recommendations in this document, while meant to aid clinical decision-making, do not preempt physician judgment in individual cases.The statements and recommendations included in this document pertain to SNM in its present form (Interstim, Medtronic) They may or may not have relevance for future SNM products or therapies which become available for clinical use.

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

“…In the literature, prognostics factors are scarce. In recent recommendations concerning SNM, Goldman et al 17 advised that only the test phase could predict the success of SNM. Indeed, neither urodynamic data nor previous BoNT‐A injections have been identified as a predictive factor for SNM failure.…”

New Technologies and Applications in Sacral Neuromodulation: An Update

“…The desire for full-body MRI-safe devices is obvious, since at least half of patients with pacemakers or neurostimulators will have a clinical indication for an MRI examination over their lifetime [3], and up to 23% of SNM explantations are currently due to the need for MRI [4]. In neurogenic subpopulations, such as multiple sclerosis, the lack of MRI compatibility has been considered a relative contraindication to SNM even though clinical benefits have been demonstrated in small case series from this subpopulation [5]. A further group of patients with lower back pain may also be excluded on this basis, some of whom may have incontinence concomitant with cauda equina syndrome.…”

Needle Placement and Position of Electrical Stimulation Inside Sacral Foramen Determines Pelvic Floor Electromyographic Response—Implications for Sacral Neuromodulation

“…Lastly, this study protocol assesses motor response during placement of the PNE needle and did not include clinical efficacy. Although motor response is currently considered as the best available predictor for successful therapy , it is unknown, if the distribution of motor nerves activated directly by neurostimulation is similar to the distribution of the rootlets stimulated for the indirect neuromodulation effect .…”