Sacral Neuromodulation: A Worldwide Survey Conducted Among Surgeons

Abstract

Aim and Objectives: The purpose of this study was to conduct a pre-guideline survey of surgeons involved in InterStim® therapy for Sacral Neuromodulation (SNM). The data gathered from the survey may serve as an important baseline in the development of a guideline for SNM implantation.Methods: Surgeons implanting SNM were surveyed using an Internet-based program between November and April of 2016. The survey was posted on the included a questionnaire.We used a questionnaire that covered various clinical aspects involved in the delivery of SNM. The questionnaire was posted on-line via Survey Monkey for a period of 5 months. The entire process was under the auspices of the Neurourology Promotion Committee of the International Continence Society (ICS).Results: 49 surgeons who are involved in SNM implant filled out the survey. We searched the literature about the best practices in those areas of interest in the delivery of SNM. We found a discrepancy in the surgical approach for SNM. Based on the results of the survey, we found discrepancies in the following areas: preoperative evaluation: voiding diary, X-ray of sacrum, uroflowmetry, urodynamic study and cystoscopic evaluation. Screening: percutaneous nerve evaluation versus stage implant. Surgical technique: anesthesia used position of electrode in sacral foramina, type of stylet and number of optimum electrodes used for stimulation. Postoperative: duration of antibiotic and number of programs given to the patient. Those differences were not based on any scientific basis in the literature rather on individual practice. Conclusion:In the current manuscript, we described the different nuances in the standard of practice for surgeons involved in the delivery of SNM therapy.As evidenced by the discrepancy in the responses, we think that this is the initial step in the preparation for a guideline describing the best policy to deliver the SNM.