1535 SURGICAL INTERVENTION FOLLOWING INTERSTIM® SACRAL NEUROMODULATION IMPLANT FOR THE MANAGEMENT OF LOWER URINARY TRACT SYMPTOMS -14 YEARS EXPERIENCE OF ONE CENTER

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-Neurogenic Voiding Dysfunction I1 Apr 20101535 SURGICAL INTERVENTION FOLLOWING INTERSTIM® SACRAL NEUROMODULATION IMPLANT FOR THE MANAGEMENT OF LOWER URINARY TRACT SYMPTOMS -14 YEARS EXPERIENCE OF ONE CENTER Ali Alzahrani and Jerzy Gajewski Ali AlzahraniAli Alzahrani More articles by this author and Jerzy GajewskiJerzy Gajewski More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1286AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Re-operation rate of the sacral neuromodulation (SNM) remains a concern. There are very few reports addressing this issue. We are reporting a 14 years experience with SNM from our center. METHODS Retrospective review of the patients data was performed to assess incidence and cause of surgical re-intervention after SNM implant between 1994 and 2008 in our center. RESULTS There were 96 SNM devices implanted in 88 women (91.7%) and 8 men (8.3%). Mean age at implantation was 45 years (SD ± 12.5). The indications for implantation were painful bladder syndrome/ interstitial cystitis (PBS/IC) (47.9%), urge urinary incontinence (UUI) (35.4%) and idiopathic urinary retention (IUR) (16.7%). The explantation rate was 20.8% and the median time to removal was 18.5 months (SD ± 31.7). The PBS/IC had the shortest time to explantation with mean of 15 months (P= 0.02). The reasons for the explantation were poor result in 12 patients (12.5%), painful stimulation in 6 patients (6.25%) and radiation of the stimulation to the leg in 2 patients (2%). The median long term follow was 50.7 months (SD ± 38.1). The long term success rate was 87.5%, 84.8% and 73 % in the IUR, UUI and PBS/IC respectively (P=0.6). In all, 39% of the patient needed revision of the SNM implant. The revision rate was highest in IUR (56%), while in UUI it was the lowest (32%). The main reason for revision was loss of stimulation in 24 procedures (58.5%). Other reasons includes pain from the pulse generator in 7 procedures (17%), painful stimulation in 5 procedures (12.2%) and radiation of the stimulation to the leg in 5 procedures (12.2%). There was drop in the rate of revision with the introduction of the tined lead technique from 50% (lead model 3092) to 31% (lead model 3893) however, this difference was not statistically significant (P=.1). The battery was changed in 8 patients and the mean battery life was 101.8 months (SD ± 23.4). CONCLUSIONS The SNM is a minimal invasive procedure with a very good long-term outcome. Re-operation rate improved with advance in surgical technique and equipment. Halifax, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e592 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Alzahrani More articles by this author Jerzy Gajewski More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...