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

Abstract

Aims To evaluate factors associated with progression to stage 2 sacral neuromodulation (SNM) for refractory overactive bladder, urinary retention, or fecal incontinence using optimal lead placement techniques with curved stylet. Methods This is a retrospective analysis of a prospectively collected database of all consecutive stage 1 SNM lead placements at our institution between August 2014 and May 2017 using optimal lead placement technique with curved stylet. Patients with refractory overactive bladder, urinary retention, or fecal incontinence were enrolled. Patients with 50% or more symptom improvement on voiding diaries were offered stage 2 implant. Demographics, clinical, and surgical characteristics were compared for patients who underwent successful stage 2 implants versus those who underwent lead removal at the end of the stage 1 trial period. Results 127 patients underwent SNM during the study period. Motor thresholds of ≤2 mA in all four electrodes were achieved in 74% of patients (94/127). A total of 89.0% (113/127) of patients received stage 2 implants. The main indication for implant, specifically urgency urinary incontinence, was positively associated with progression to stage 2 implant. Male gender, history of pelvic pain and previous SNM were negatively associated with progression to stage 2 implant. Conclusions Our findings demonstrate that the contemporary optimized lead placement technique resulted in low motor thresholds and successful progression to stage 2 SNM implant in the majority of our cohort. Predictive factors associated with success or failure may potentially guide decision making for therapeutic interventions and counseling patient expectations.

One‐year outcomes of the ARTISAN‐SNM study with the Axonics System for the treatment of urinary urgency incontinence

“…As reported previously, 4 we hypothesize that several factors may contribute to the high therapy responder rate. A recent study by Adelstein et al 9 (2019) showed that high trial success rates (88%) can be achieved by optimal lead placement which includes the use of the curved stylet. The adoption of best practice techniques 5,10,11 for optimal lead placement undoubtedly contributed to the success in this study as evidenced by the 88% responder rate at 1 month.…”

Two‐year outcomes of the ARTISAN‐SNM study for the treatment of urinary urgency incontinence using the Axonics rechargeable sacral neuromodulation system

“…The magnitude of these results shows that most of the participants were well‐above the traditional criteria for therapy success defined as a greater than 50% reduction in UUI episodes. The high clinical efficacy of the study results is likely influenced by the use of optimal lead placement techniques, 8,15–17 minimal lead migrations, and the constant‐current stimulation provided by the Axonics System. Additional studies are necessary to understand the impact of these and other factors on therapy success.…”

Treatment of Fecal Incontinence With a Rechargeable Sacral Neuromodulation System: Efficacy, Clinical Outcome, and Ease of Use—Six-Month Follow-Up

“…The standardized implant technique using the curved stylet leading to intra-operative motor thresholds below 2 mA, could attribute to the improved outcome. In patients with such low motor thresholds, success rates of 89% have been reported in short term for patients with overactive bladder, nonobstructive urinary retention, or FI (5,10,11). Long-term efficacy remains to be proven.…”