1370 TINED LEAD VERSUS PERCUTANEOUS NERVE EVALUATION FOR SACRAL NERVE STIMULATOR ASSESSMENT

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence, Evaluation & Therapy (III)1 Apr 20131370 TINED LEAD VERSUS PERCUTANEOUS NERVE EVALUATION FOR SACRAL NERVE STIMULATOR ASSESSMENT Julie Jenks, Rizwan Hamid, Julian Shah, Tamsin Greenwell, and Jeremy Ockrim Julie JenksJulie Jenks London, United Kingdom More articles by this author , Rizwan HamidRizwan Hamid London, United Kingdom More articles by this author , Julian ShahJulian Shah London, United Kingdom More articles by this author , Tamsin GreenwellTamsin Greenwell London, United Kingdom More articles by this author , and Jeremy OckrimJeremy Ockrim London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2724AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral nerve stimulation (SNS) is a two-stage procedure. The test phase can be performed as an office-based local anaesthetic percutaneous nerve evaluation (PNE) requiring second stage placement of a new (tined) lead, or by the initial implantation of a permanent tined lead under general anaesthesia. Preliminary data has suggested that overall success rates are higher with initial placement of the permanent tined lead than in staged PNE-SNS approach. We evaluated the outcomes of both techniques. METHODS Seventy consecutive patients had either PNE (n=35) or tined lead (n=35) evaluation and conversion to a permanent SNS implant according to response. Primary outcomes were assessed using frequency-volume charts, pad testing, ICIQ/EQ5D questionnaires and pain scores. Success was considered as greater than 50% reduction in frequency-urgency-incontinence episodes, pad weights, symptom scores or pain parameters. Minimum follow up was 12 months. Statistical analysis was performed with paired t-tests. RESULTS Nineteen (54%) of the tined lead and fifteen (43%) of the PNE patients were converted to permanent implant (p<0.05). One tined lead was explanted for infection. All tined lead patients have successful implants although one is switched off for implant pain. Five of fifteen (30%) of PNE evaluations have failed to convert test efficacy to the permanent implant (p<0.05). Two PNE patients have been successfully salvaged by the implantation of a second tined lead. CONCLUSIONS Success rates were significantly higher in patients when tined lead testing was used as primary modality for SNS testing compared with those who had PNE. All patients with successful tined lead testing had successful conversion to permanent implant, whereas 30% of those PNE testing had incomplete response when converted to a permanent implant. This may be due in part to difficulties retaining accurate lead placement with the two lead (PNE-SNS) approach. We recommend tined lead evaluation for first stage SNS evaluation. This has important cost and logistical implications for SNS services. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e560-e561 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julie Jenks London, United Kingdom More articles by this author Rizwan Hamid London, United Kingdom More articles by this author Julian Shah London, United Kingdom More articles by this author Tamsin Greenwell London, United Kingdom More articles by this author Jeremy Ockrim London, United Kingdom More articles by this author Expand All Advertisement Advertisement Loading ...