A modified approach to patient’s selection with improved clinical outcomes in sacral nerve modulation

Abstract

Introduction: Since the marketing of the percutaneous permanenttined leads (PPTL), many centres rely solely on these instead ofthe percutaneous nerve evaluation (PNE) as a screening tool. Atour centre, we routinely perform PNE. Moreover, with our limitedhospital resources, we have adopted a stricter definition of successin the patient selection process using an improvement of morethan 60% as a cut-off point. This study presents our experiencewith sacral nerve stimulation using PPTL as an adjunct to PNE toimprove the outcome of the screening method for patients sufferingfrom refractory voiding dysfunction.Methods: We reviewed the charts of 106 patients who underwenta PNE between 2001 and 2008. The outcome of the procedures,the complication rates and its long-term effect were reviewed.Results: Overall, 116 PNE were performed and it was successfulin 54%. Forty-five out of the 62 patients with a successful PNEunderwent the stage I procedure. Of these, 93% had a successfulstage I and were later implanted with the implantable pulse generator(IPG). The remaining 12 patients underwent the simultaneousimplantation of the PPTL and IPG using the open procedure andit was successful in 10 of them.Conclusion: The PNE is a good adjunct to the staged procedureto select the appropriate candidates for sacral nerve stimulation,especially with limited resources.