Predictors of reoperation after sacral neuromodulation: A single institution evaluation of over 400 patients

Peters, Kenneth M.; Killinger, Kim A.; Gilleran, Jason; Bartley, Jamie; Wolfert, Cheryl; Boura, Judith

doi:10.1002/nau.22929

Cited by 42 publications

(33 citation statements)

References 16 publications

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“…The literature is inconsistent regarding an assumed association between BMI and efficacy during PNE for both FI and UI, but increased rates of reoperations and complications have been described in SNM patients with a lower BMI [37][38][39][40][41]. While series exploring the predictors of SNM for FI have failed to show an association between BMI and outcome [8,29,30], a relation between low BMI and unfavourable outcome, as shown in our study, has also been demonstrated in urological patients [37,38,41] and children [39]. Bilateral migration of tined leads in a thin patient has been thoroughly discussed by Kessler et al [41].…”

Section: Discussionmentioning

confidence: 99%

Sacral neuromodulation for faecal incontinence following obstetric sphincter injury – outcome of percutaneous nerve evaluation

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Sacral neuromodulation for faecal incontinence following obstetric sphincter injury – outcome of percutaneous nerve evaluation

et al. 2017

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“…In a prospective longitudinal study, investigators found that among other factors, decreased BMI, had a higher risk of reoperation. 41 In another study, the results suggested that lower BMI might predict reoperation, however, BMI was not significant when adjusted for other covariates. 42 A more recent retrospective review also failed to find any associations between obesity and reoperation.…”

Section: Sacral Neuromodulationmentioning

confidence: 95%

“…The study model estimated that a woman with a BMI of 25 would have a roughly 50% greater chance of achieving ≥50% improvement in UUI compared with a BMI of 35. In a prospective longitudinal study, investigators found that among other factors, decreased BMI, had a higher risk of reoperation . In another study, the results suggested that lower BMI might predict reoperation, however, BMI was not significant when adjusted for other covariates .…”

Section: Treatment Of Oab and Uui—does Obesity Affect Outcome?mentioning

confidence: 97%

Exploring the relation between obesity and urinary incontinence: Pathophysiology, clinical implications, and the effect of weight reduction, ICI‐RS 2018

Marcelissen

Anding

Averbeck

et al. 2019

Neurourology and Urodynamics

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Aims: To evaluate the relationship between obesity and urinary incontinence (UI) and to determine the effect of weight reduction on the severity of incontinence. (Bristol, UK): "What are the relationships between obesity and UI, and the effects of successful bariatric surgery?"Results: Obesity is an increasing problem worldwide and is associated with many adverse effects on health and quality of life. From both translational and clinical studies, there is a strong relationship between obesity and the occurrence of UI.Both mechanical and metabolic factors seem to play an important role including systemic inflammation and oxidative stress due to the release of cytokines in visceral adipose tissue. The success rate of anti-incontinence surgery does not seem to be greatly affected by body mass index (BMI), although reliable data and longterm follow-up are currently lacking. Both weight reduction programs and bariatric surgery can result in amelioration of UI. Various studies have shown that weight loss (particularly that associated with bariatric surgery) can reduce incontinence, and the degree of weight loss is positively correlated with improvement in symptoms. Conclusions: Obesity is strongly associated with an increased prevalence of both stress and urgency UI. The treatment outcome does not seem to be highly dependent on BMI. Weight reduction is positively correlated with improvement of incontinence symptoms and therefore should be advocated in the management. K E Y W O R D Sbariatric surgery, obesity, overweight, urinary incontinence 1 | INTRODUCTION Obesity has become a major global health challenge and the worldwide prevalence of obesity has nearly tripled between 1975 and 2016. According to the latest report of the World Health Organization more than 1.9 billion adults (39% of men and 40% of women) were overweight (body mass index [BMI], ≥25 kg/m 2 ) in 2016 and over

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“…10,11 Although pelvic pain has not previously been reported as a negative predictor for SNM success, it has been shown to predict reoperation. 12 Several baseline characteristics were found to have no association with successful stage 2 SNM implant. These included age, comorbidities, BMI, presence of urodynamic DO, history of neurogenic bladder, and surgical characteristics.…”

Section: Discussionmentioning

confidence: 95%

“…In other studies, SNM has been explored as an off label therapy for indication of pelvic pain . Although pelvic pain has not previously been reported as a negative predictor for SNM success, it has been shown to predict reoperation …”

Section: Discussionmentioning

confidence: 99%

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

Adelstein

Lee

Gioia

et al. 2019

Neurourology and Urodynamics

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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.

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Predictors of reoperation after sacral neuromodulation: A single institution evaluation of over 400 patients

Abstract: In this largest known series to date, one third of the patients required reoperation and the most common reason was lack of efficacy/worsening symptoms. Ongoing study is needed as the technology continues to evolve. Neurourol. Urodynam. 36:354-359, 2017. © 2015 Wiley Periodicals, Inc.

Cited by 42 publications

References 16 publications

Sacral neuromodulation for faecal incontinence following obstetric sphincter injury – outcome of percutaneous nerve evaluation

Sacral neuromodulation for faecal incontinence following obstetric sphincter injury – outcome of percutaneous nerve evaluation

Exploring the relation between obesity and urinary incontinence: Pathophysiology, clinical implications, and the effect of weight reduction, ICI‐RS 2018

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

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