Predictive Factors in Sacral Neuromodulation: A Systematic Review

Jairam, Ranjana; Drossaerts, Jamie; Marcelissen, Tom; Koeveringe, Gommert van; Vrijens, Desiree; Kerrebroeck, Philip Van

doi:10.1159/000513937

Cited by 24 publications

(21 citation statements)

References 86 publications

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“…A systematic review showed that female gender tends to be more successful in SNM 20 . To date we have no precise diagnostic criteria for voiding parameters in females, and this may be a limitation in studies that evaluate the treatment outcomes in voiding phase of females.…”

Section: Discussionmentioning

confidence: 99%

“…10 A systematic review showed that female gender tends to be more successful in SNM. 20 To date we have no precise diagnostic criteria for voiding parameters in females, and this may be a limitation in studies that evaluate the treatment outcomes in voiding phase of females. However, in our study, male had a good response to treatment, too, and there are limited studies that investigate it, and still, there are a gap of knowledge in this issue.…”

Section: Discussionmentioning

confidence: 99%

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Sacral neuromodulation in patients with detrusor underactivity: Is biological sex an indicator?

Onur

Tayebi

Salehi‐Pourmehr

et al. 2022

Neurourology and Urodynamics

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Objectives This study aimed to report sacral neuromodulation (SNM) outcomes in detrusor underactivity (DU). Methods A multicentric, multinational, retrospective case series was conducted between March 2017 and June 2021 in three different referral centers. Initial test phase stimulation included either a percutaneous nerve evaluation (PNE) or an advanced lead evaluation test phase (ALTP) before permanent SNM implantation. The test phases were performed under local anesthesia, either in the outpatient (PNE) or operating room (ALTP), in the prone position, which was implanted in the third or fourth sacral foramina under fluoroscopic guidance. Patients with favorable response to the initial test phase during the first 2 weeks underwent the implantable pulse generator (IPG) implantation (Medtronic neurostimulation generator device InterStim™). Favorable response was defined as ≥ 50% improvement in symptoms, frequency of clean intermittent catheterization (CIC) and/or decrease in postvoid residual (PVR), increase in voided volume, or improvement in bladder voiding efficiency (BVE) based on the bladder diary. Results Fifty‐eight patients were recruited with a mean age of 39.95 ± 15.28 years. Among the 58 cases, 36 (62.1%) patients responded to the initial stage. Of these, 12 patients (30.8%) with non‐neurogenic etiology and nine patients (52.9%) with neurologic etiology did not respond to the initial test phase; thus, they did not undergo full implantation (p = 0.141). Voided volume, PVR, and the median maximum flow rate (Qmax) improved significantly (p < 0.001) in both sexes; however, there was no statistical difference between both genders. Most female cases (78.3%), and nearly half of the men (51.4%), responded to the test phase and were candidates for the IPG phase. Among the 35 cases who underwent IPG, 27 patients (72.2% of males, and 77.8% of females; p = 0.700) had a favorable response to IPG. 46.6% of patients had a successful outcome at the end of the study. Conclusion This multicentric study showed that SNM effectively and safely provided symptom improvement in refractory DU in males similar to females which is an important finding as previously it has been suggested that SNM works better in nonobstructive urinary retention in women and not in women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sacral neuromodulation in patients with detrusor underactivity: Is biological sex an indicator?

Onur

Tayebi

Salehi‐Pourmehr

et al. 2022

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

“…There is a paucity of data regarding the lead position in clinical studies. In particular, little is known as to whether lead position relative to the nerve affects clinical outcome [ 16 ]. The type of implantation varies, with no standardized technique defined in previous trials.…”

Section: Discussionmentioning

confidence: 99%

“…This is surprising given the longevity of SNM surgery. A recent systematic review observed no consensus over predictive factors for success in SNM [ 16 ]. It included only two studies that examined the effect of electrode position, determined by the depth, angle and deflection with respect to the sacral foramen.…”

Section: Discussionmentioning

confidence: 99%

Comparison of surgical techniques for optimal lead placement in sacral neuromodulation: a cadaver study

et al. 2022

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Background Sacral neuromodulation (SNM) is a common treatment for patients with urinary and faecal incontinence. A close contact of the tined lead electrode with the targeted nerve is likely to improve functional outcome. The aim of this study was to compare the position of the SNM lead in relation to the sacral nerve by comparing different implantation techniques. Methods This cadaver study was conducted at the Division of Anatomy of Vienna's Medical University in October 2020. We dissected 10 cadavers after bilateral SNM lead implantation (n = 20), using two different standardized implantation techniques. The cadavers were categorized as group A (n = 10), representing the conventional guided implantation group and group B (n = 10), where SNM implantation was conducted with the novel fluoroscopy-guided “H”-technique. The primary goal was to assess the distance between the sacral nerve and the lead placement. Results The electrodes were inserted at a median angle of 58.5° (46–65°) in group A and 60° (50–65°) in group B, without reaching statistical significance. In 8 cadavers, the lead entered the S3 foramen successfully. The median distance of the lead to the nerve did not show a significant difference between both groups (E0: Group A: 0.0 mm vs. Group B: 0.0 mm, p = 0.969; E1: Group A: 0.0 mm vs. Group B: 0.5 mm p = 0.754; E2: Group A: 2.5 mm vs. Group B: 2.5 mm p = 1.000; E3: Group A: 3.5 mm vs. Group B: 4.0 mm p = 0.675). In 2 cases (20%) of the conventional group A, the lead was misplaced and located at the gluteal muscle. Perforation of the presacral fascia was observed in one lead placement in group A and in two placements in group B. Conclusions Both standardized implantation techniques may ensure close electrode proximity to the targeted nerve. Misplacement of the electrode was more often observed with the conventional implantation technique.

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“…Studies evaluating predictors of treatment success for SNM have not found any consistent predictive factors. 30,31 At least five studies have analyzed whether demographic or urodynamic factors can predict success or complications from BTX injection. [32][33][34][35][36] In studies including men and women, women are more likely to have successful outcomes.…”

Section: Personalized Oab Carementioning

confidence: 99%

Delivering patient‐centered care through shared decision making in overactive bladder

Paudel

Lane

2022

Neurourology and Urodynamics

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Introduction Men and women living with overactive bladder (OAB) face many treatment decisions as they progress through the treatment pathway. Decisions to pursue specific therapies are highly preference sensitive and ideal for shared decision making (SDM). The aim of this narrative review is to provide urologists with a practical summary of methods to elicit preferences and facilitate SDM to promote patient‐centered care for OAB. Methods We explore OAB as a preference sensitive condition through a review of treatment outcomes and present available data on prediction tools, patient preferences, and decision aids. We propose a paradigm for applying Everyday SDM to OAB care. Results Clinical outcome data points to equipoise (balanced outcomes) between options for first‐, second‐, and third‐line OAB therapies, making OAB preference sensitive and appropriate for SDM. Methods to personalize care through individualized outcome prediction calculators and tools to elicit patient preferences are emerging. While patient information about OAB is readily available, we identified few OAB decision aids that facilitate patient preference elicitation and SDM. Conclusions OAB is a preference sensitive condition, where treatment is largely based on the patient's preferences and values. SDM is an ideal approach to supporting patients through these treatment decisions. We propose the application of Everyday SDM, a personalized, clinically efficient methodology as a method to support patient‐centered OAB care.

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Predictive Factors in Sacral Neuromodulation: A Systematic Review

Cited by 24 publications

References 86 publications

Sacral neuromodulation in patients with detrusor underactivity: Is biological sex an indicator?

Sacral neuromodulation in patients with detrusor underactivity: Is biological sex an indicator?

Comparison of surgical techniques for optimal lead placement in sacral neuromodulation: a cadaver study

Delivering patient‐centered care through shared decision making in overactive bladder

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