Sacral neuromodulation remote programming in patients with refractory lower urinary tract dysfunction: China’s experience during the COVID-19 pandemic

Abstract

ObjectivesSacral neuromodulation is an effective, minimally invasive treatment for refractory lower urinary tract dysfunction. However, regular postoperative programming is crucial for the maintenance of the curative effects of electronic sacral stimulator devices. The outbreak of coronavirus disease 2019 (COVID-19) limited the ability of practitioners to perform traditional face-to-face programming of these stimulators. Therefore, this study aimed to evaluate the application of remote programming technology for sacral neuromodulation during the COVID-19 pandemic in China.Materials and methodsWe retrospectively collected data including baseline and programming information of all patients with lower urinary tract dysfunction who underwent sacral neuromodulation remote programming in China after the outbreak of COVID-19 (i.e., December 2019). The patients also completed a self-designed telephone questionnaire on the subject.ResultsA total of 51 patients from 16 centers were included. They underwent 180 total remote programming visits, and 118, 2, 25, and 54 voltage, current, pulse width, and frequency adjustments, respectively, were performed. Additionally, remote switching on and off was performed 8 times; impedance test, 54 times; and stimulation contact replacement, 25 times. The demand for remote programming was the highest during the first 6 months of sacral neuromodulation (average, 2.39 times per person). In total, 36 out of the 51 patients completed the questionnaire survey. Of these, all indicated that they chose remote programming to minimize unnecessary travel because they had been affected by COVID-19. The questionnaire also showed that remote programming could reduce the number of patient visits to the hospital, save time, reduce financial costs, and would be easy for patients to master. All surveyed patients indicated that they were satisfied with remote programming and were willing to recommend it to other patients.ConclusionRemote programming for sacral neuromodulation is feasible, effective, safe, and highly recommended by patients with refractory lower urinary tract dysfunction. Remote programming technology has great development and application potential in the post-pandemic era.

Remote programming in stage I sacral neuromodulation: a multicentre prospective feasibility study

“…In other results, our questionnaire survey showed that a significant proportion came from rural areas. And the survey also indicated that most patients chose to undergo sacral nerve modulation therapy due to refractory NLUTD, aligning with previous research 10 . The economic cost of programming for most patients was not as high as initially imagined, but the time cost was substantial, underscoring the significant practical value of remote programming.…”

“…To the best of our knowledge, the presented study is the first multicenter research focusing on the remote programming of Stage I SNM patients. In our team’s previous research, we found that remote programming might help address the aforementioned problem 10 . However, most of these studies were retrospective, and as far as we know, patients receiving sacral nerve modulation therapy are predominantly those with refractory lower urinary tract dysfunction, often accompanied by intense subjective symptoms such as voiding difficulty, urinary frequency, and pain.…”

“…Prior research has shown significant discrepancies between retrospective subjective data and real-time semi-objective data, likely due to patients’ tendency to embellish or exaggerate their recollections 20 , 21 . Additionally, previous studies mainly focused on patients with permanent implants who require fewer programming adjustments, making remote programming less beneficial 10 . Therefore, we designed a prospective case-control study, focusing on patients in the observation period following stage I implantation surgery, who frequently require programming adjustments to find suitable parameters.…”

“…The remote programming system adopted by the presented was developed and launched by Tsinghua Pins Medical Technology Co., Ltd. in 2019, is currently applicable in several neuromodulation system 10 , 12 , 13 . The system comprises three main components: the Doctor’s Console, the Patient’s Interface, and the Central Server terminal.…”

“…In simple terms, this technology allows patients to contact their physicians via the internet or mobile 4G/5G networks, from the comfort of their homes or any location with internet access, to adjust parameters and improve their symptoms. This technology undoubtedly alleviates many of the aforementioned challenges, and prior research by our team suggests that patients have benefited from it 10 . However, whether Stage I patients can benefit from remote control and whether it is beneficial for the conversion to Stage II remains a subject for further investigation.…”