The Influence of Electrode Configuration Changes on the Sensory and Motor Response During (Re)Programming in Sacral Neuromodulation

Tilborghs, Sam; Borne, Sigrid Van de; Vaganée, Donald; Win, Gunter De; Wachter, Stefan De

doi:10.1016/j.neurom.2021.09.001

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…Generally, a pattern is selected that produces a perineal sensation on the patient and is then adjusted to a subsensory level for therapy delivery [4]. Altering the contact pattern influences both the sensation location and the amplitude required to elicit it during sensory threshold testing and can be used for optimizing and troubleshooting SNM therapy [9].…”

Section: Introductionmentioning

confidence: 99%

Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols

et al. 2022

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Purpose: We quantified patient record documentation of sacral neuromodulation (SNM) threshold testing and programming parameters at our institution to identify opportunities to improve therapy outcomes and future SNM technologies.Methods: A retrospective review was conducted using 127 records from 40 SNM patients. Records were screened for SNM documentation including qualitative and quantitative data. The qualitative covered indirect references to threshold testing and the quantitative included efficacy descriptions and device programming used by the patient. Findings were categorized by visit type: percutaneous nerve evaluation (PNE), stage 1 (S1), permanent lead implantation, stage 2 (S2) permanent impulse generator implantation, device-related follow-up, or surgical removal.Results: Documentation of threshold testing was more complete during initial implant visits (PNE and S1), less complete for S2 visits, and infrequent for follow-up clinical visits. Surgical motor thresholds were most often referred to using only qualitative comments such as “good response” (88%, 100% for PNE, S1) and less commonly included quantitative values (68%, 84%), locations of response (84%, 83%) or specific contacts used for testing (0%). S2 motor thresholds were less well documented with qualitative, quantitative, and anatomical location outcomes at 70%, 48%, and 36% respectively. Surgical notes did not include specific stimulation parameters or contacts used for tests. Postoperative sensory tests were often only qualitative (80%, 67% for PNE, S1) with quantitative values documented much less frequently (39%, 9%) and typically lacked sensory locations or electrode-specific results. For follow-up visits, <10% included quantitative sensory test outcomes. Few records (<7%) included device program settings recommended for therapy delivery and none included therapy-use logs.Conclusions: While evidence suggests contact and parameter-specific programming can improve SNM therapy outcomes, there is a major gap in the documentation of this data. More detailed testing and documentation could improve therapeutic options for parameter titration and provide design inputs for future technologies.

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Section: Introductionmentioning

confidence: 99%

Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols

et al. 2022

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Is Our Limited Understanding of the Effects of Nerve Stimulation Resulting in Poor Outcomes and the Need for Better “Rescue Programming” in SNM and PTNS, and Lost Opportunities for New Sites of Stimulation? ICI‐RS 2024

Averbeck,

Gajewski,

Finazzi‐Agrò

et al. 2024

Neurourology and Urodynamics

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AimsSacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) are strongly recommended by international guidelines bodies for complex lower urinary tract dysfunctions. However, treatment failure and the need for rescue programming still represent a significant need for long‐term follow‐up. This review aimed to describe current strategies and future directions in patients undergoing such therapies.Materials and MethodsThis is a consensus report of a Think Tank discussed at the Annual Meeting of the International Consultation on Incontinence – Research Society (ICI‐RS), June 6–8, 2024 (Bristol, UK): “Is our limited understanding of the effects of nerve stimulation resulting in poor outcomes and the need for better ‘rescue programming’ in SNM and PTNS, and lost opportunities for new sites of stimulation?”ResultsRescue programming is important from two different perspectives: to improve patient outcomes and to enhance device longevity (for implantable devices). Standard SNM parameters have remained unchanged since its inception for the treatment of OAB, nonobstructive urinary retention, and voiding dysfunction. SNM rescue programming includes intermittent stimulation (cycling on), increased frequency and changes in pulse width (PW). The effect of PW setting on SNM outcomes remains unclear. Monopolar configurations stimulate more motor nerve fibers at lower stimulation voltage; hence, this could be an option in patients who failed bipolar stimulation in the long term. Unfortunately, there is little evidence for rescue programming for PTNS. However, the development of implantable devices for intermittent stimulation of the tibial nerve may increase long‐term adherence to therapy and increase interest in alternative programming. There has been recent promising neurostimulation targeting the pudendal nerve (PNS), especially in BPS/IC. More recently, preliminary data addressed the benefits of high‐frequency bilateral pudendal nerve block for DESD and adaptive PNS on both urgency and stress UI in women.ConclusionThe exploration of rescue programming and new stimulation sites remains underutilized, and there are opportunities that could potentially expand the therapeutic applications of nerve stimulation. By broadening the range of target sites, clinicians may be able to tailor treatments according to individual patient needs and underlying conditions, thereby improving overall outcomes. However, further studies are still needed to increase the level of evidence, potentially allowing for an individualized treatment both in patients who are candidates for electrostimulation and in those who have already received surgical implants but seek a better outcome.

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A Deep Analysis of the Pelvic Floor Motor Response in Sacral Neuromodulation Linking It to Outcome

Tilborghs,

Van de Borne,

Vaganée

et al. 2024

Neuromodulation: Technology at the Neural Interface

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The Influence of Electrode Configuration Changes on the Sensory and Motor Response During (Re)Programming in Sacral Neuromodulation

Cited by 3 publications

References 30 publications

Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols

Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols

Is Our Limited Understanding of the Effects of Nerve Stimulation Resulting in Poor Outcomes and the Need for Better “Rescue Programming” in SNM and PTNS, and Lost Opportunities for New Sites of Stimulation? ICI‐RS 2024

A Deep Analysis of the Pelvic Floor Motor Response in Sacral Neuromodulation Linking It to Outcome

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